title: Extension of limb salvage by combined vascular reconstruction and adjunctive free-tissue transfer.
abstract: 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.
authors.affiliation: Division of Plastic Surgery, University of Rochester Medical Center, NY 14642.
authors.forename: J M
authors.initials: JM
authors.lastname: Serletti
authors.forename: S R
authors.initials: SR
authors.lastname: Hurwitz
authors.forename: J A
authors.initials: JA
authors.lastname: Jones
authors.forename: H R
authors.initials: HR
authors.lastname: Herrera
authors.forename: G P
authors.initials: GP
authors.lastname: Reading
authors.forename: K
authors.initials: K
authors.lastname: Ouriel
authors.forename: R M
authors.initials: RM
authors.lastname: Green
mesh_terms: 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