[Choice of microvascular anastomoses in reconstructive surgery].

For reconstruction of traumatic defects, choosing the most suitable free flap and vessels for microvascular anastomoses is paramount. Careful clinical examination, followed by a Doppler-ultrasonography and arteriography is mandatory. An end-to-end anastomosis is desirable if the artery is interrupted distally. In all other cases end-to-side anastomoses should be used since they do not compromise distal blood flow. In the case of the "chinese" forearm free flap, one should always reconstruct the donor radial artery with a vein graft to assure optimal blood supply of the hand. This free flap should not be used in the rare cases where the arterial arcade of the hand is absent.