Free flap transfer is a useful technique for treating severely injured upper extremities with soft tissue defects. In patients who suffer from soft tissue defects due to high energy trauma, there is a large gap between the defect and the anastomosis site. Vein grafts can be used to solve this problem, but it is also reported that this technique increases the complication rate. We had two patients who underwent reconstruction with free flap using the AV loop technique. Both cases had large soft tissue defects and had previously undergone revascularization with vein graft at the time of injury, making the reconstruction procedure more complicated. The free flap with a 20 - 30 cm AV loop in both cases survived and there were no major complications. The AV loop technique is a reliable method for free flap reconstruction in complex injuries with extensive soft tissue defects.
