title: Lower limb revascularization and free flap transfer for major ischemic tissue loss.
abstract: The objective of this study was to assess the value of lower limb revascularization and free flap transfer (LLR-FFT) in the management of critical leg ischemia and major tissue loss. A total of 29 consecutive patients with critically ischemic leg and major tissue loss underwent 24 simultaneous and 6 staged LLR-FFT procedures. The main outcome measures were bypass graft patency, free flap viability, leg salvage, patients alive with salvaged leg, and survival. At the 2-year follow-up, the bypass graft patency rate was 85%, secondary free flap viability rate was 82%, and 82% of patients achieved leg salvage and were ambulant. If the success was defined as patients being alive with a salvaged leg, the corresponding rate was 80%. Three patients achieved long-term primary patency and leg salvage despite free flap failure, which occurred during the 30-day postoperative period. Lower extremity revascularization plus free flap coverage of large ischemic lesions is valuable in achieving long-term leg salvage. Because revascularization and conventional management of major tissue loss alone can be effective in the management of a small number of cases, staged LLR-FFT is indicated, when appropriate, for better selection of patients undergoing such an aggressive and demanding treatment.
authors.affiliation: Department of Plastic Surgery, Helsinki University Central Hospital, Finland.
authors.forename: E
authors.initials: E
authors.lastname: Tukiainen
authors.forename: F
authors.initials: F
authors.lastname: Biancari
authors.forename: M
authors.initials: M
authors.lastname: Lepäntalo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005734:Gangrene / Q000150:complications / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery*; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D007871:Leg Ulcer / Q000150:complications / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D013524:Surgical Flaps; D016019:Survival Analysis; D016896:Treatment Outcome; D014654:Vascular Patency