Deep Inferior Epigastric Artery and Vein Interposition Grafts for Free Anterolateral Thigh Flap Reconstruction

Free flaps for coverage of soft tissue wounds of the lower extremity are often used in the setting of large, complex wounds or failed local flaps. However, in cases of insufficient pedicle length or poor recipient vessel availability, interposition grafts (IGs) may be used to extend the range of flaps. The deep inferior epigastric artery and vein are typically harvested for breast reconstruction with free deep inferior epigastric artery perforator flaps. However, their use as IGs has been described, albeit sparsely, mostly in non-deep inferior epigastric artery perforator breast reconstruction, genitourinary reconstruction, and revascularization for hand ischemia cases. Here, we describe the first reported instance of deep inferior epigastric artery and vein IGs in series for successful free flap coverage of a complex lower extremity wound and demonstrate the potential utility of these vessels in achieving sufficient coverage when faced with insufficient pedicle length or recipient vessels. We additionally demonstrate the efficacy of using these vessels in series when encountered with a particularly lengthy defect where a single IG is not sufficient to span the defect.