Copyright © 2019 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited. www.PRSJournal.com 912 A rteriosclerosis with or without critical isch- emia, trauma, infections, or extensive onco- logic resections commonly leads to a paucity of adequate recipient vessels for microvascular anastomosis. The placement of arteriovenous loops enables the creation of high-fow and low-resistance short circuits between distant recipient arteries and veins. 1–4 The division of an arteriovenous loop before fap anastomosis establishes two interpositional vein grafts that can be adjusted to the ideal length to enable tension-free microvascular anastomosis (Fig. 1). 5–7 The optimal time for fap anastomosis to an arteriovenous loop remains controversial. A recently published meta-analysis yielded a sig- nifcantly higher rate of major complications and Disclosure: The authors have no financial dis- closures. The funding of this study was solely institutional. Copyright © 2019 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0000000000005386 Dominic Henn, M.D. Matthias S. T. Wähmann, M.D. Miriam Horsch, B.S. Svetlana Hetjens, Ph.D. Thomas Kremer, M.D. Emre Gazyakan, M.D. Christoph Hirche, M.D. Volker J. Schmidt, M.D. Günter Germann, M.D., Ph.D. Ulrich Kneser, M.D. Ludwigshafen and Heidelberg, Germany Background: The optimal time for fap anastomosis to an arteriovenous loop remains controversial. Whether perforator faps and axially vascularized mus- cle or fasciocutaneous faps lead to comparable outcomes in conjunction with arteriovenous loops has not been investigated. Methods: Medical records from 103 patients undergoing arteriovenous loop reconstruction (76 one-stage and 27 two-stage) between 2007 and 2017 were reviewed. Postoperative outcomes were compared between one- and two-stage arteriovenous loop reconstructions and different types of free faps. Results: Rates of fap thrombosis, major wound complications, and fap fail- ure did not differ signifcantly between one- and two-stage arteriovenous loop reconstructions (14.47 percent versus 11.11 percent, p = 1.00; 30.26 percent versus 25.93 percent, p = 0.67; and 10.53 percent versus 7.41 percent, p = 1.00). For two-stage arteriovenous loop reconstructions, the time interval between arteriovenous loop placement and fap anastomosis was a predictor for throm- botic events (OR, 1.31; p < 0.05). Anterolateral thigh faps in conjunction with arteriovenous loops showed higher failure rates (33.33 percent) compared with all other faps (6.59 percent) (p < 0.05) and combined latissimus dorsi and parascapular faps (0 percent) (p < 0.05). Thrombosis rates were higher in anterolateral thigh faps (33.33 percent) compared with all other faps (10.99 percent; p = 0.056), and combined latissimus dorsi and parascapular faps (0 percent; p < 0.05). Conclusions: Two-stage arteriovenous loop reconstructions do not lead to increased postoperative complications compared to one-stage arteriovenous loop reconstructions and may be favorable in complicated cases because of shorter operative times. To avoid an increased thrombosis risk, fap anasto- mosis should not be delayed beyond 10 days in two-stage arteriovenous loop reconstructions. Anterolateral thigh faps are less suitable for arteriovenous loop reconstructions because of higher complication rates. (Plast. Reconstr. Surg. 143: 912, 2019.) CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. From the Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, and the Depart- ment of Medical Statistics, University Medicine Mannheim, University of Heidelberg; and the Ethianum, Clinic for Plas- tic, Reconstructive and Aesthetic Surgery, Orthopedic Sur- gery, Partner Hospital of Heidelberg University. Received for publication March 9, 2018; accepted July 27, 2018. Presented at the 63rd Annual Meeting of the Plastic Sur- gery Research Council, in Birmingham, Alabama, May 17 through 20, 2018. One-Stage versus Two-Stage Arteriovenous Loop Reconstructions: An Experience on 103 Cases from a Single Center RECONSTRUCTIVE