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J Reconstr Microsurg 2018; 34(05): 334-340
DOI: 10.1055/s-0037-1621746
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Proximal versus Distal Recipient Vessels in Lower Extremity Reconstruction: A Retrospective Series and Systematic Review

John T. Stranix
1   Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University Langone Medical Center, New York, New York
,
Zachary M. Borab
1   Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University Langone Medical Center, New York, New York
,
William J. Rifkin
1   Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University Langone Medical Center, New York, New York
,
Adam Jacoby
1   Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University Langone Medical Center, New York, New York
,
Z-Hye Lee
1   Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University Langone Medical Center, New York, New York
,
Lavinia Anzai
1   Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University Langone Medical Center, New York, New York
,
Daniel J. Ceradini
1   Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University Langone Medical Center, New York, New York
,
Vishal Thanik
1   Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University Langone Medical Center, New York, New York
,
Pierre B. Saadeh
1   Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University Langone Medical Center, New York, New York
,
Jamie P. Levine
1   Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University Langone Medical Center, New York, New York
› Author Affiliations
Further Information

Publication History

26 August 2017

19 November 2017

Publication Date:
06 April 2018 (online)

Also available atMedOne
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Abstract

Background Recipient vessels proximal to the zone of injury have traditionally been preferred for lower extremity reconstruction. However, more recent data have shown mixed outcomes when performing anastomoses distal to the zone of injury. We investigated the impact of recipient vessel location on free flap outcomes.

Methods Retrospective review (1979–2016); 312 soft tissue free flaps for open tibia fractures met inclusion criteria. Flap characteristics and perioperative outcomes were examined. Systematic review identified articles evaluating anastomosis location and flap outcomes; pooled data analysis was performed.

Results More anastomoses were performed proximal to the zone of injury (80.7%) than distal (19.3%). Distal anastomoses were not associated with increased take back rates (19.6%) compared with proximal (23.8%) anastomoses (p = 0.356). Regression analysis comparing proximal and distal anastomoses found no difference in partial flap failures (7.4% vs 11.9%; p = 0.978) or total flap failures (9.3% vs 9.3%; p = 0.815) when controlling for the presence of arterial injury, flap type, and time from injury to coverage. Systematic review yielded 11 articles with 1,245 proximal and 127 distal anastomoses for comparison. Pooled analysis (p = 0.58) and weighted comparative analysis (p = 0.39) found no difference in flap failure rates between proximal and distal groups.

Conclusion Our results are congruent with the current lower extremity literature and demonstrate no difference in perioperative complication rates between anastomoses performed proximal or distal to the zone of injury. These findings suggest that anastomotic location choice should be based primarily on recipient vessel quality/flow and ease of access/exposure rather than orientation relative to the zone of injury.

Keywords

lower extremity reconstruction - zone of injury - recipient vessels

Financial Support

None.