We retrospectively evaluated severe extremity injuries with two free flaps at our hospital. There were 12 free flaps from 6 patients: 3 cases in the lower leg, and 1 each in the foot, forearm, and hand. Regarding the reasons for multiple flaps, 3 cases required reconstruction for tissue deficits, 2 cases were for free flap failures, and 1 was for delayed osteomyelitis. Three cases in which damaged vessels were used for the recipient vessels using the end-to-end technique had severe vascular spasms during surgery, and 2 of the 3 cases resulted in complete flap loss. Vessels with a greater than twice-the-size vascular mismatch were used in 7 anastomoses, including 4 arteries and 3 veins. Among them, 2 venous anastomoses required end-to-side anastomosis. We should carefully choose suitable recipient vessels for severe extremity injuries in order to avoid flap failure caused by refractory vasospasm. In addition, we believe that performing anastomosis using the end-to-side technique will maintain peripheral blood flow and minimize the need for dissection around vessels. This may preserve the anastomosis site for multiple tissue reconstruction.
