Arteriovenous fistula with a saphenous long loop.

After radiation, chronic infection or previous operations recipient vessels for free tissue transfer become difficult to find. It may be necessary to locate vessels remote from the area of reconstruction and to construct long venous grafts. Long venous grafts can be compressed in the tissue tunnels that may be required. In this series of patients, an arteriovenous fistula was created with a long saphenous loop 10 to 21 days prior to tissue transfer. The saphenous loops were placed close to the area for reconstruction and when divided at the time of transplantation, provided one artery and one vein. In this series of 12 cases, adequate vascularization was achieved in 10 cases. In the other 2 cases, we believe that maturation of the fistula may have been necessary before proper function. The other advantages of the technique are: the procedure can be carried out under local anaesthesia, ease of positioning of the patient on the operating table, and a reduction in the time taken to perform the tissue transfer.