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.
Division of Plastic and Orthopedic Surgery, University of Kentucky College of Medicine, Lexington, KY 40536-0284, USA. lpu@uky.edu
Lee L Q
LL
Pu
Daniel A
DA
Medalie
William J
WJ
Rosenblum
Steven J
SJ
Lawrence
Henry C
HC
Vasconez
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