Reconstruction of a severely traumatized lower limb with a composite defect, in the chronic stage, is theoretically possible by free composite-tissue transfer of anatomic dimensions. However, in practice, because of extensive fibrosis around the bony defect and the extension of perivascular fibrosis for several centimeters beyond the visible limits of trauma, a healthy recipient pedicle is not available in the vicinity of the defect. Since most composite flaps have a short pedicle, vein grafts have to be used for both the artery and the vein. The procedure becomes very demanding of both time and skill and is prone to complications. Prefabrication of a recipient vascular pedicle is done by creating a popliteosaphenous shunt by means of a vein graft 1 week before definitive flap transfer. The procedure becomes two-staged but safe. The operating time is short in each sitting. The prefabricated recipient pedicle can be made to reach almost next to the bony defect; thus there is freedom of flap selection. The anastomosis is technically simple. I have used the prefabricated recipient vascular pedicle method to salvage 11 cases of extensive leg trauma in the chronic stage by transfer of large composite-tissue flaps with no failures.
(C)1995American Society of Plastic Surgeons