The inferior mesenteric vessels as recipients when performing free tissue transfer for pelvic defects following abdomino-perineal resection. A novel technique and review of intra-peritoneal recipient vessel options for microvascular transfer

Abstract

Successful microvascular transfer of tissue is dependent upon suitable vessels not only of the donor tissue but also at the recipient site. Congenital deformities, previous surgery, infection or irradiation at the recipient site may render vessels less suitable for this purpose. Under such circumstances it becomes desirable to identify suitable recipient vessels remote to the compromised area. In cases where external beam radiotherapy has been delivered, the superficial surface area damaged can be rather extensive precluding the use of even the longest of flap pedicles--a problem potentially addressed by searching for recipient vessels deep to the tissue planes affected. We report one such case where the inferior mesenteric vessels were used as recipient vessels for the microvascular transfer of a free Latissimus Dorsi musculocutaneous flap to reconstruct an extensive perineal defect following abdomino-perineal resection where the vessels would otherwise serve no purpose. Whilst a limited number of intra-peritoneal vessels have previously been reported as recipient vessels for free flap surgery there has not been, to our knowledge, any report of utilising the inferior mesenteric artery (Inf Mes A). Whilst based on a single case report, this article examines the literature describing microvascular transfer of tissue to compromised recipient sites and it reviews previously reported recipient vessel options available when reconstructing the perineum, abdominal wall or trunk with particular emphasis on intra-peritoneal options.