title: [Extended skin and soft tissue defects after vascular wounds: plastic surgical concepts].
abstract: BACKGROUND
  Skin and soft-tissue defects at the ischaemic lower extremity represent a challenging condition. Major amputations can be prevented by optimised surgical therapy. The aim of any intervention is the revascularisation and defect reconstruction of the extremity.
  
  
  METHODS
  This article aims to provide a structured overview on up-to-date therapeutic strategies and differentiated indications for certain surgical flaps in combination with bypass surgery for the treatment of chronic "vascular" wounds.
  
  
  RESULTS
  Optimised conservative wound therapy, skin grafts, pedicled or microsurgical free flaps in combination with vascular bypasses can be applied to salvage ischaemic extremities. These operations require an interdisciplinary cooperation between vascular surgeons and plastic surgeons.
  
  
  CONCLUSIONS
  These procedures should accordingly only be performed in specialised high-volume centres with significant vascular surgical and microsurgical expertise.
authors: Plastisch- und Handchirurgische Klinik, Universitätsklinikum Erlangen, Deutschland.
authors: U
authors: U
authors: Kneser
authors: A
authors: A
authors: Arkudas
authors: J P
authors: JP
authors: Beier
authors: A
authors: A
authors: Dragu
authors: A
authors: A
authors: Stübinger
authors: W
authors: W
authors: Lang
authors: R E
authors: RE
authors: Horch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D001158:Arteries / Q000601:surgery; D003131:Combined Modality Therapy; D015897:Comorbidity; D003238:Connective Tissue / Q000098:blood supply*; D003299:Cooperative Behavior; D003925:Diabetic Angiopathies / Q000601:surgery*; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D007869:Leg Injuries / Q000601:surgery*; D023821:Limb Salvage / Q000379:methods; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012307:Risk Factors; D012867:Skin / Q000098:blood supply* / Q000293:injuries; D013524:Surgical Flaps / Q000098:blood supply* / Q000601:surgery*