Temporary arteriovenous shunt prior to free flap transfer.

The establishment of a temporary arteriovenous shunt (TAVS) near a recipient site with inadequate local vessels may facilitate the subsequent re-vascularization of a free flap. In nine patients a TAVS was constructed prior to the transfer of free flaps. The indication was either the absence of vessels or inadequate recipient vessels. In eight of the nine patients the establishment of the shunt proved successful. In one patient a re-creation of the shunt was necessary owing to thrombosis caused by infection. In another patient the shunt thrombosed and no further microvascular surgery was possible. The construction of a TAVS increases the possibility of more extensive application of free flap transfer. Should the creation of the shunt prove futile, the donor flap may still be salvaged for further application. A staged transfer of a free flap after the primary establishment of a TAVS gives the best changes for adequate vascularization of the flap and reduces the risk of thrombosis.