ABSTRACT
The selection of recipient vessels distal to an extremity defect can be a tantalizing option, offering the potential advantage
of rapid accessibility to relatively large vessels that, in turn, would simplify revascularization
of any desired microsurgical tissue transfer. However, such a maneuver contradicts
the traditional dictum that any microanastomosis should be proximal to the zone of injury. A retrospective review of experiences with free flaps to the
extremities corroborated this predilection for proximally-based flaps, which were
successful in 115 of 136 cases (84.6 percent). Eleven distally-based flaps were also
attempted: four were converted intraoperatively to proximally-based flaps; one was
moved to an even more distal site, necessitating an interposition vein graft; and
one totally failed. Although six (54.5 percent) distally-based flaps were ultimately
successful, the incidence of problems encountered overall negated most benefits, so
that this option for recipient vessels would rarely be justified.
