title: Free-tissue transfer for lower-extremity reconstruction in the immunosuppressed diabetic transplant recipient.
abstract: The technique of free-tissue transfer for complex wounds has become a common tool in reconstructive surgery. The use of this modality in immunosuppressed transplant patients, who often have associated metabolic and vascular disease, has not been well-documented. The authors report three cases of lower-extremity reconstruction in renal-transplant recipients, utilizing microvascular free-tissue transfer. All three patients were hypertensive diabetic patients with symptomatic peripheral vascular disease and chronic wounds. One patient presented with an exposed Achilles tendon; the second had a complex wound of the forefoot; and the third patient had a large ulceration on the heel of the right foot. These three patients underwent successful free-tissue transfer, and have regained full use of their limbs and ambulation. Free-tissue transfer in the immunosuppressed transplant recipient is a viable reconstructive option. Careful perioperative metabolic monitoring and surgical care are critical for success. A multispecialty approach is advocated, to coordinate limb salvage in these patients.
authors.affiliation: Division of Plastic Surgery, Ohio State University, Columbus, Ohio 43210-1228, USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Armstrong
authors.forename: R E
authors.initials: RE
authors.lastname: Villalobos
authors.forename: D M
authors.initials: DM
authors.lastname: Leppink
mesh_terms: D000125:Achilles Tendon / Q000601:surgery; D000328:Adult; D002908:Chronic Disease; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000378:metabolism / Q000601:surgery*; D017719:Diabetic Foot / Q000601:surgery*; D005205:Fascia / Q000637:transplantation; D005545:Forefoot, Human / Q000601:surgery; D006365:Heel / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000150:complications; D016867:Immunocompromised Host; D016030:Kidney Transplantation; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D010348:Patient Care Team; D016491:Peripheral Vascular Diseases / Q000150:complications; D016038:Skin Transplantation / Q000379:methods; D013524:Surgical Flaps / Q000379:methods*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures