A 15-year experience with combined vascular reconstruction and free flap transfer for limb-salvage.
OBJECTIVE
To evaluate the results and complications of combined simultaneous arterial re-vascularisation and free flap transfer in patients with critical limb ischaemia and large soft-tissue defects that would otherwise have required major amputation.


METHODS
Retrospective analysis of all combined procedures performed between 1993 and 2007 with regard to complications and outcome.


METHODS
Seventy-eight procedures were performed in 76 patients with a mean age of 60 years (range: 18-80 years). The majority had diabetes (70.5%). Follow-up was obtained from hospital charts and telephone contacts with patients or GPs.


RESULTS
The limb-salvage rate was 93% after 1 year, 80% after 3 years and 71% after 5 years. Perioperative complications occurred in 50% of the patients; six out of 78 (7.7%) arterial reconstructions and 13 out of 78 (16.7%) flaps had to be revised during the early postoperative period. However, most flaps could be saved by a secondary procedure resulting in an early failure (amputation) rate of 6%. In-hospital mortality was 3.8%. End-stage renal disease was the only factor predicting limb loss. In total, 65% of the patients survived and were able to walk on their reconstructed limb at 1-year follow-up. Combined survival and limb-salvage rates were 85%, 66% and 51% after 1, 3 and 5 years.


CONCLUSIONS
Combined arterial re-vascularisation and free flap transfer can be performed safely with acceptable morbidity and mortality and should be considered for every mobile patient with large soft-tissue deficit (>10cm(2)) without end-stage renal disease prior to major amputation.
Randon
C
C
Department of Vascular Surgery, Ghent University Hospital, 2C2 De Pintelaan 185, 9000 Gent, Belgium. caren.randon@ugent.be
Jacobs
B
B
De Ryck
F
F
Van Landuyt
K
K
Vermassen
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D016638:Critical Illness; D017719:Diabetic Foot / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D005528:Foot / Q000098:blood supply*; D017052:Hospital Mortality; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications; D023821:Limb Salvage / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013524:Surgical Flaps / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D055815:Young Adult