Extension of limb salvage by combined vascular reconstruction and adjunctive free-tissue transfer.
OBJECTIVE
Vascular reconstruction alone can be insufficient for extremity salvage in some patients with severe soft-tissue wounds. We present our experience in 20 patients with vascular reconstruction for ischemic disease and free-tissue transfer for limb-threatening soft-tissue wounds.


METHODS
Nineteen patients underwent autogenous venous bypasses and one patient underwent an aortobifemoral bypass. Ten soft-tissue reconstruction were performed at the time of the vascular reconstruction and 10 were delayed. Free-tissue transferred included muscle, fasciocutaneous flaps, and omentum. Inflow to the flap was from the bypass graft (n = 12) or the distal tibial artery.


RESULTS
One free flap and graft failed immediately in the same patient. One successful flap and graft required a below-knee amputation for ongoing infection in the surrounding soft tissues. Eighteen of 20 patients have had free-flap and graft patency during the mean follow-up period of 17 months (range 6 to 33 months). These 18 patients ambulate independently.


CONCLUSIONS
In patients with arterial insufficiency and severe soft-tissue wounds, combined vascular reconstruction and free-tissue transfer permits extended limb salvage with excellent functional results.
Serletti
J M
JM
Division of Plastic Surgery, University of Rochester Medical Center, NY 14642.
Hurwitz
S R
SR
Jones
J A
JA
Herrera
H R
HR
Reading
G P
GP
Ouriel
K
K
Green
R M
RM
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D007866:Leg / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D013524:Surgical Flaps / Q000379:methods*; D015996:Survival Rate; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000379:methods