Abstract
Background The use of vascular grafts is indicated in case of insufficient pedicle length or
for complex defects involving both soft tissues and vessels. Venous grafts (for both
venous and arterial reconstructions) and arterial grafts (arterial reconstruction)
can be used. This study retrospectively evaluated the needs for vascular reconstruction
and its results in a clinical series of lower limb reconstructions with microsurgical
free flaps.
Materials and Methods From 2010 to 2015, a total of 16 vascular grafts or flow-through flaps were used
in 12 patients out of a total of 150 patients undergoing microsurgical reconstruction
(8%). Arterial reconstruction was performed in seven cases (six flow-through flaps,
one arterial graft), combined arterial and venous reconstruction in four cases (three
vein grafts, one combined venous/arterial graft), and venous reconstruction in one
case (one venous graft). The rate of complications and donor-site morbidity related
to vascular graft harvest were evaluated.
Results Reconstruction was successful in all cases, despite an overall complication rate
of 17 and 8% of surgical revision. Donor-site morbidity, subjectively evaluated, was
minimal with respect to functional deficits and aesthetic outcome. Indications for
the different types of grafts are discussed.
Conclusion The use of vascular grafts is needed in a relevant percentage of microsurgical reconstruction
cases. Venous and arterial vascular grafts, transient arteriovenous fistulas, and
“flow-through” microsurgical flaps showed a safe reconstruction comparable to microsurgical
reconstructions without the use of grafts. Donor-site morbidity secondary to vascular
graft harvest is minimal, and in almost 70% of cases no additional scars are needed.
Keywords
vascular grafts - lower limb reconstruction - microsurgery
