Segmental Hemihyperplasia-Related Macrodactyly with Congenital Renal Agenesis: A Hand Surgeon's Point of View

655 procedure has logistic and economic advantages over the two-stage procedure [2]. However, some other surgeons advocate the use of the one-stage procedure. The largest case series on this topic was published in Taiwan, with 34 cases: 28 one-stage and six two-stage procedures. In this case series, the occlusion rate in the one-stage procedure group was 29%, with an 11% flap failure rate, whereas 50% of the two-stage loops occluded, with a 33% flap loss rate. The authors demonstrated that two-staged arteriovenous loop is even more disappointing from the point of flap survival [2]. In summary, the use of an arteriovenous loop makes a neovascular system possible and is a useful method for solving unexpected vascular problems at an inadequate recipient site. Therefore, we conclude that an arteriovenous loop can be used as a breakthrough tool to overcome unexpected problems of micro-reconstruction in poorly vascularized lower extremities.