• Dong Yeon Kim, Yeon Ji Lee, Suk-Ho Moon, Jung Suk Oh, Yoon-Seok Koh, Jang Yong Kim, Sun Cheol Park, and Ho Jong Chun.
• Department of Plastic and Reconstructive Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
• J Plast Reconstr Aesthet Surg. 2019 Jul 1; 72 (7): 1100-1109.

BackgroundAs the microsurgical and interventional revascularization techniques are evolving, traditionally amputated limbs are now challenged to salvage. However, a calcified recipient vessel is a common but challenging problem encountered in lower extremity reconstruction.MethodsAn end-to-side anastomosis of a vein graft (1.5-3.5 cm in length) was performed to the recipient vessel when it was difficult to clamp the recipient vessel near the defect because of the inelastic and hard vessel wall. The vascular clamp was applied to the vein graft, and the flap's pedicle was anastomosed to the vein graft.ResultsA total of 18 free flaps (10 ALT cases, 4 TDAP cases, 2 PAP cases, and 2 SCIP cases) were anastomosed with a bridge vein graft to the heavily calcified recipient vessels (7 ATA cases, 3 PTA cases, 7 DPA cases, and 1 MPA case). Overall flap survival rate was 83.3%. Limb salvage rate was 93.7%, and anastomosis patency rate was 94.4% CONCLUSION: Vein conduit in an end-to-side anastomosis of severely calcified recipient vessels shows a reasonable limb salvage rate. It acts as a buffer, which makes microscopic vessel manipulation easier. If vessel calcification is the only drawback for a free flap reconstruction, then a vein graft needs to be prepared instead of an amputation. This method may extend the surgical option to more high-risk patients in lower extremity microsurgical reconstruction and increase the limb salvage rate.Copyright © 2019 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

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