Poster Presentation NZ Association of Plastic Surgeons & NZ Society for Surgery of the Hand

Which is more successful? Single versus two-stage arteriovenous loops in free flap reconstruction. (1446)

Sam Hamilton 1 , Justin Easton 2 , John Beer 2 , Raminder Dhillon 2
  1. Plastic and Reconstructive Surgery , Monash Health, Melbourne, VIC, Australia
  2. Plastic and Reconstructive Surgery, Austin Health, Heidelberg, Victoria, Australia


Arteriovenous loops (AVL) provide high flow, low resistance, large caliber vessels from out site of the zone of injury and are a useful adjunct for reconstruction of vessel deplete defects1. Single and two stage techniques are described in the literature2. We aim to compare single versus two stage AVL techniques with a case presentation and literature review.



We present a case of single-stage AVL for reconstruction of defect overlying total knee reconstruction with exposed metal, followed by literature review.



AVL have a higher rate of complications compared to primary anastomosis1. Case series have shown equal success rate with both single and two stage techniques, with some studies suggesting completion of the second stage within ten days to reduce thrombosis rates2. However, a recent meta-analysis found that single stage techniques have a statistically significant lower rate of complications3.


Increased rates of thrombosis with anterolateral thigh free flaps compared to other free flaps have also been shown2.



Single stage AVL are the preferred technique when an AVL is required for successful free flap reconstruction. However, both techniques can provide distant vessels for free flap anastomosis when there is a paucity of local recipient vessels.   


  1. Cavadas PC. Arteriovenous vascular loops in free flap reconstruction of the extremities. Plast Reconstr Surg. 2008;121(2):514-20.
  2. Henn D, Wähmann MST, Horsch M, Hetjens S, Kremer T, Gazyakan E, et al. One-Stage versus Two-Stage Arteriovenous Loop Reconstructions: An Experience on 103 Cases from a Single Center. Plast Reconstr Surg. 2019;143(3):912-24.
  3. Knackstedt R, Aliotta R, Gatherwright J, Djohan R, Gastman B, Schwarz G, et al. Single-stage versus two-stage arteriovenous loop microsurgical reconstruction: A meta-analysis of the literature. Microsurgery. 2018;38(6):706-17.