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CC BY 4.0 · Indian J Plast Surg
DOI: 10.1055/s-0045-1811169
Original Article

A Comparative Analysis of Clinical Outcomes between Proximal and Distal Recipient Vessel Microanastomosis for Lower Limb Reconstruction

Authors

  • Ebenezer J. C. Asirvatham

    1   Department of Plastic and Reconstructive Surgery, Christian Medical College, Vellore, Tamil Nadu, India

  • Bala Prasanth J 

    1   Department of Plastic and Reconstructive Surgery, Christian Medical College, Vellore, Tamil Nadu, India

  • Atul Philipose

    1   Department of Plastic and Reconstructive Surgery, Christian Medical College, Vellore, Tamil Nadu, India

  • Jonathan Victor

    1   Department of Plastic and Reconstructive Surgery, Christian Medical College, Vellore, Tamil Nadu, India

  • Ashish Kumar Gupta

    1   Department of Plastic and Reconstructive Surgery, Christian Medical College, Vellore, Tamil Nadu, India

  • Shashank Lamba

    1   Department of Plastic and Reconstructive Surgery, Christian Medical College, Vellore, Tamil Nadu, India
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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

Patients' Consent

Informed consent was obtained from all the participants of the study.




Publication History

Article published online:
25 September 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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