When direct circulatory access for free flap reconstruction is difficult or impossible, vein grafts may provide free flap circulation. In the lower extremity the short saphenous vein87 has many attributes, which make it ideal for use, when vascular access is not available and long vein grafts are needed. These include:
1. Sufficient length of 40-50 cm depending on patient habitus. This length may be used to serve as a direct arterial graft from higher up on the limb, while local veins are used for flap drainage, or the long vein graft may be doubled into an A-V loop to provide both arterial and venous components (Fig. 7.6).
Fig. 7.4. G, right, and H, below) Postoperative appearance. Note normal contour of the chin.
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