title: Free Tissue Transfer for Limb Salvage in High-Risk Patients: Worth the Risk.
abstract: CONCLUSIONS
  Mircosurgical free tissue transfer is a powerful tool in the arsenal of reconstructive surgeons, oftentimes as the final option in limb salvage before amputation. Patients presenting for limb salvage frequently carry with them multiple co-morbidities such as diabetes mellitus, end-stage renal disease, and peripheral vascular disease. Surgeons are oftentimes hesitant to attempt free tissue tranfer in these medically complex individuals due to beliefs that the patient would not tolerate prolonged anesthesia, the surgery is doomed to fail, or the patient would be better off with an amputation. Because amputees actually demonstrate higher mortality rates, the decision to not to proceed with limb salvage should be made with great care.
  
  
  BACKGROUND
  By reviewing the success rates with free tissue transfer for limb salvage in high-risk patients, the target articles have shown that this option is indeed viable even in this patient population. Specifically, reasonable success rates are presented for limb salvage using free tissue transfer in patients with end-stage renal disease, a single-vessel leg and critical limb ischemia.
  
  
  RESULTS
  The articles reviewed demonstrate that free tissue transfer for limb salvage in properly selected patients with end-stage renal disease or severe peripheral vascular disease is worth attempting. Before surgery, these patients must undergo a complete cardiac work-up regardless of previous cardiac history.
  
  
  CONCLUSIONS
  When necessary, free tissue transfer should be pursued by the reconstructive surgeon even in high-risk medically complex patients.
authors: Department of Plastic Surgery, Center for Wound Healing, Georgetown University Hospital , Washington, District of Columbia.
authors: Matthew
authors: M
authors: Endara
authors: Department of Plastic Surgery, Center for Wound Healing, Georgetown University Hospital , Washington, District of Columbia.
authors: Ivica
authors: I
authors: Ducic
authors: Department of Plastic Surgery, Center for Wound Healing, Georgetown University Hospital , Washington, District of Columbia.
authors: Christopher
authors: C
authors: Attinger