Use of the Pedicle of a Previous Free Flap as Recipient Vessels in Complex Microsurgical Reconstruction: A Series of 28 Cases

Background Selection of recipient vessels represents one of the most important preoperative and intraoperative decisions. In many patients, adequate vessels are unavailable near the defect due to prior surgery, radiation, trauma, or previous free flap reconstruction. Techniques such as vein grafts, vascular loops, and interposition composite arteriovenous bundles have been described to overcome these limitations, although each carries specific disadvantages. Methods The authors present a retrospective case series of 28 free flaps in 26 patients in whom pedicles from previous free flaps were used as recipient vessels for secondary free tissue transfer. Patient demographics, indications, flap types, surgical technique, and postoperative outcomes were evaluated. Results Previous flap pedicles were successfully used as recipient vessels in all cases. One flap failure occurred due to septic pedicle thrombosis, resulting in an overall flap survival rate of 96.4%. Complications and technical considerations are analyzed. Conclusion The pedicle of a previous free flap represents a reliable and versatile recipient vessel option in select complex reconstructive cases. This approach expands reconstructive possibilities when conventional recipient vessels are unavailable and should be considered within the reconstructive algorithm for secondary microsurgical procedures. This technique allowed avoidance of vein grafts or alternative distant recipient vessel dissection in most patients.