Free tissue transfer to a difficult wound of the lower extremity.
Amputation is still recommended to patients with a difficult wound of the lower extremity because limb salvage after free tissue transfer in these patients remains uncertain. During the past 3 years, the authors studied 15 patients (11 men, 4 women; age range, 17-71 years) with difficult wounds of the lower extremities who had free tissue transfers for limb salvage. Eleven patients had an extensive soft-tissue defect (nearly the entire length) of the legs or feet, and 4 had a composite-tissue defect of the legs or feet that required bony reconstruction. A total of 16 free tissue transfers (13 free muscle flaps, 2 osteomusculocutaneous flaps, and 1 adipofascial flap) were performed in 15 patients (1 patient had bilateral transfers). A saphenous vein loop or graft was used in 3 patients and a subsequent bone graft was done in 2 patients. Free tissue transfer was accomplished successfully in 14 patients (93%). Limb salvage was achieved ultimately in 12 patients (80%) who were able to ambulate during a 36-month follow-up. The authors believe that free tissue transfer for limb salvage in any patient with a difficult wound of the lower extremity is still a worthwhile procedure and should be attempted if possible. Meticulous preoperative preparation and intraoperative execution combined with the use of innovative microsurgical techniques are the keys for success.
Pu
Lee L Q
LL
Division of Plastic and Orthopedic Surgery, University of Kentucky College of Medicine, Lexington, KY 40536-0284, USA. lpu@uky.edu
Medalie
Daniel A
DA
Rosenblum
William J
WJ
Lawrence
Steven J
SJ
Vasconez
Henry C
HC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D003646:Debridement; D005260:Female; D006801:Humans; D007866:Leg / Q000601:surgery*; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D016879:Salvage Therapy; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome