ABSTRACT
The authors present a method of free flap reconstruction using the short saphenous
vein, when local vessels are not available in the lower extremity. Initially, a temporary
arteriovenous fistula is created. This is subsequently divided to provide both arterial
access and venous drainage for the flap. The use of the short saphenous vein has a
number of advantages: 1) forty to 50 cm of length are available; 2) the vein is relatively
thin-walled and has a nearly constant diameter throughout its length; 3) the vein
may be left in situ at its upper end in some patients; 4) the vein drains into both the long saphenous
and the popliteal veins. Thus, double drainage is provided. This may be of importance
in patients with impaired outflow secondary to deep venous thrombosis or obstruction.
5) The separated vein graft components allow accurate ultrasonic monitoring of both
arterial and venous circulation. Seven cases are presented of type Illb and IIIc tibial
fractures in which regional vessels were not accessible. Free flap reconstruction
using in situ short saphenous vein grafts was successful in all seven patients. The anatomy of
the short saphenous vein and surgical technique are considered.
