Free Flap Outcomes in Severe Lower Extremity Trauma: Anastomosis within vs. outside the Zone of Trauma

Objectives: In severe lower extremity trauma, free flap transfer is often required for limb salvage. Microvascular anastomosis is conventionally performed outside the zone of trauma (ZOT). However, in cases involving extensive soft tissue defects, anastomosis within the ZOT may be unavoidable. The associated clinical outcomes remain insufficiently clarified. This study aimed to evaluate the impact of anastomosis within the ZOT on flap outcomes by comparing cases performed within and outside the ZOT.