Preferential Use of the Posterior Approach to Blood Vessels

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Lower Leg in Microvascular Surgery. Godina-Marko. Arnez-Zoran-M. Lister-Graham-D. Ljubljana, Yugoslavia, and Salt Lake City, Utah. From the University Department of Plastic Surgery and Burns at the Ljubljana University Medical Center and the Division of Plastic Surgery at the University of Utah School of Medicine. Received for publication August 14, 1989. Revised September 4, 1990. Plastic and Reconstructive Surgery. 1991 Aug. 88(2). pp 287-291. A posterior approach to the vessels of the lower leg, with particular emphasis on the posterior tibial artery, is presented as the method of choice for microvascular free-tissue transfer to the region. This approach offers wide exposure, better definition of the zone of injury, appropriate selection of the recipient vessel and of the site of anastomosis, and enough room for microsurgical work. Exposing the large posterior tibial artery down to the distal third of the lower leg facilitates the use of end-to-side anastomosis and makes the transfer of large muscle flaps to that region more predictable, in part by obviating the need for long vein grafts. This exposure leaves no functional and few aesthetic deficits.