Microvascular anastomosis through the tibial tunnel: a new technique in free-tissue transfer to the leg.

Free-tissue transfer to a severely traumatized leg has a high rate of vascular complications. We present three successful cases using a new technique of microvascular anastomosis through the tibial tunnel. Because of the unavailability of anterior tibial artery due to posttraumatic vascular disease, donor vascular pedicles were passed posterior to the tibia through the tibial tunnel and anastomosed to the posterior tibial artery or its branch in an end-to-end fashion. The flaps survived perfectly, without any vascular complication. This technique represents a safe route, and the shortest route, to an expected anastomosis point. Our technique is indicated especially in cases with a single-vessel leg.