Various Clinical Applications of Pedicle T-Anastomosis in Free Flap Reconstruction

In free flap transfer, the recipient vessel is commonly sacrificed for pedicle anastomosis. Considering that the recipient vessel is one of the main supplying vessels for circulation, preservation of its patency is important in the extremities of aged or chronic vasculopathy patients, especially diabetics. T-anastomosis of the flap pedicle is a useful technique for preserving the patency of recipient vessels. A highly branched proximal vascular system can provide a branched pedicle with a proper diameter. A T-shaped interpositional vascular anastomosis of the pedicle makes it possible to supply the flap itself, combined with preservation of distal recipient flow.

Interpositional T-anastomoses were used to preserve the radial (12), ulnar (2), anterior tibial (16), and posterior tibial arteries (11). The dominant recipient vessels were preserved (19) and a single remnant recipient vessel was saved in the traumatic extremity (10) or in chronic vasculopathy patients (16). The thoracodorsal or lateral circumflex femoral system was a good source for a branched pedicle; therefore, the latissimus or anterolateral thigh perforator flap was used for the preservation of recipient flow. The T-anastomosis could be planned for preservation of the donor vessel and it was useful in perforator flaps for the balance of flow and pressure between the flow to the flap and to the recipient vessel.

T-anastomosis of the flap pedicle was recommended as a technique in free flap transfer, and was considered as more applicable than end-to-side anastomosis, with the advantages of easier technique and no risk of kinking. Beside preservation of recipient flow, this anastomosis is available for many purposes, such as flow balance in a large or long perforator flap, reconstruction of additional flow, confirmation of arterial anastomosis, and for a chimeric pattern. With this technique, the same recipient vessel can be used again for required additional flap reconstruction.