Abstract
Background
This study aims to compare the clinical outcomes of lower limb free-flap reconstruction
with vascular anastomosis performed proximal versus distal to the zone of injury.
Very few comparative studies on this topic have been published to date. These studies
are discussed in this article.
Materials and Methods
A retrospective analysis of microvascular free-flap reconstructions for lower extremity
defects over a 5-year period, from 2018 to 2023, was conducted. Outcomes of vascular
anastomosis distal to the zone of injury were compared with those proximal to the
zone of injury. Clinical parameters evaluated included flap failure, arterial and
venous compromise, operative takebacks, and their success rates.
Results
Of the 101 cases included in our analysis, 81 underwent vascular anastomosis proximal
to the zone of injury, and 20 underwent distal anastomosis. In total, 72 (88.88%)
proximal and 18 (90%) distal anastomoses were successful. Arterial thrombus occurred
in 1 case (5%) among those who underwent distal anastomosis and in 4 cases (4.9%)
of the proximal anastomosis cohort, whereas venous thrombus was seen in 1 case (5%)
of the distal group and 12 cases (14.81%) of the proximal group. No statistically
significant differences were found in clinical outcomes between the groups.
Conclusion
Free tissue transfer using recipient vessels distal to the zone of injury is a reliable
option for lower limb reconstruction. Distal anastomosis, which can be technically
less challenging, demonstrates survival rates comparable to proximal anastomosis and
can be considered a viable approach in selected patients.
Keywords
lower limb reconstruction - recipient vessels - distal versus proximal - anastomosis
