SELECTION OF RECIPIENT VESSELS FOR FREE FLAPS TO THE DISTAL LEG AND FOOT FOLLOWING TRAUMA

The recipient vessels are of prime importance in free flap transfers t o the lower limbs. To determine the incidence and pattern of vascular trauma, a study was carried out in 126 patients who had Gustillo Type III open fractures of the distal legs and feet that required free flap s for wound coverage. In comparison with the posterior tibial artery, the anterior tibial artery has a much higher incidence of injury with more extensive damage. It can be injured at a more proximal level than estimated from gross inspection during surgery. This should be borne in mind when the anterior tibial artery is selected as the recipient a rtery in order to prevent reexploration and failure of the flaps. Howe ver, the posterior tibial artery is much less vulnerable to damage in most injuries and is more reliable as the recipient artery. In this se ries there was no problem in finding proper recipient veins in the leg s. A general principle is proposed for selecting recipient vessels in crushed legs, with a warning against the pitfalls that have been encou ntered. (C) 1994 Wiley-Liss, Inc.