Using a Y-Shaped Vein Graft with Drain-out Branches to Provide Additional Arterial Sources for Free Flap Reconstruction in Injured Lower Extremities.

Background: Reconstruction of the distal lower extremity with poor arterial circulation is achallenge for reconstructive surgeons, especially when a microsurgical freetissue transfer is necessary. One may face the problem of having no suitablerecipient artery to be used except the main one. To overcome this difficultsituation, utilization of a Y-shaped vein graft (YVG) was developed.Methods: We report on 3 successful reconstructions of the lower extremities with freeflaps using YVG to supply the arterial inflow and in which the distal circulationof the lower extremity was preserved at the same time. The therapeuticgoals, design, surgical technique, and outcomes are clarified. The indications,advantages, and disadvantages are also discussed.Results: All 3 patients achieved successful reconstruction of the affected limbs withuneventful surgery. Special microsurgical skills are unnecessary in thismethod. It can provide an additional arterial source, which is useful and reliablefor revascularizing various kinds of free tissue. Utmost care must betaken to examine the direction of flow during harvesting since only the drainoutbranches can serve as an ideal YVG.Conclusion: We concluded that Y-shaped vein grafting is a good alternative technique toachieve free flap reconstruction of a distal lower extremity with simultaneouspreservation of the distal circulation in selected difficult cases.