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 a challenge for reconstructive surgeons, especially when a microsurgical free tissue transfer is necessary. One may face the problem of having no suitable recipient artery to be used except the main one. To overcome this difficult situation, utilization of a Y-shaped vein graft (YVG) was developed. Methods: We report on 3 successful reconstructions of the lower extremities with free flaps using YVG to supply the arterial inflow and in which the distal circulation of the lower extremity was preserved at the same time. The therapeutic goals, 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 with uneventful surgery. Special microsurgical skills are unnecessary in this method. It can provide an additional arterial source, which is useful and reliable for revascularizing various kinds of free tissue. Utmost care must be taken to examine the direction of flow during harvesting since only the drain-out branches can serve as an ideal YVG. Conclusion: We concluded that Y-shaped vein grafting is a good alternative technique to achieve free flap reconstruction of a distal lower extremity with simultaneous preservation of the distal circulation in selected difficult cases.