Free flap circulation is usually reestablished by direct anastomosis to regional arteries and their companion veins. These are most often exposed through an incision proximal to, yet connected with the defect. The vessels are followed from proximal to the zone of injury until any vascular damage is noted and avoided. The proper site for the anastomosis to undamaged vessels can then be selected. In extremity reconstruction occasionally distal exposure is possible for "upside down" flap placement if both arterial and venous flow are normal.
Preoperative angiography is sometimes indicated to define vascular anatomy. Adverse effects from angiography have occasionally been noted93 and therefore it is preferable to avoid angiography within 24 hours of a planned free flap transfer to
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