title: Successful lower extremity salvage with free flap after endovascular angioplasty in peripheral arterial occlusive disease.
abstract: OBJECTIVE
  Most patients with peripheral arterial occlusive disease undergo lower limb amputation due to complex wounds on their lower extremities. We have taken the challenging approach of combining angioplasty and free tissue transfer for limb salvage.
  
  
  METHODS
  Between October 2011 and December 2013, 11 patients (average age of 56.8 years; ranged from 43-72 years old) with peripheral arterial occlusive disease of main tibioperoneal arteries underwent preoperative angioplasty. Afterward, free tissue transfers (nine anterolateral thigh free flaps, one vastus lateralis muscle free flap, and one deep femoral artery perforator flap) were performed on these patients for lower extremity salvage and reconstruction.
  
  
  RESULTS
  All 11 free tissue transfers after angioplasty were successful without operative mortality or major complications. Minimal wound dehiscence was seen in one case, and partial flap necrosis was seen in the other cases. During the follow-up period, all of the patients had their wounds healed completely and achieved acceptable contour and quality of gait.
  
  
  CONCLUSIONS
  The preoperative angioplasty provides well-vascularized tissue that both controls infection and helps free flaps to survive. Therefore, the patients due to receive leg amputation in spite of the free tissue transfer can achieve limb salvage by using the additional technique of angioplasty. This combined approach was successful in preserving the functional aspects along with the aesthetic results for the lower limb reconstruction.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Suwon, South Korea.
authors.forename: Yu Jin
authors.initials: YJ
authors.lastname: Jang
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Suwon, South Korea.
authors.forename: Myong Chul
authors.initials: MC
authors.lastname: Park
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Ajou University Hospital, Suwon, South Korea.
authors.forename: You Sun
authors.initials: YS
authors.lastname: Hong
authors.affiliation: Department of Radiology, Ajou University Hospital, Suwon, South Korea.
authors.forename: Je Hwan
authors.initials: JH
authors.lastname: Won
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Ajou University Hospital, Suwon, South Korea.
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Lim
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Suwon, South Korea.
authors.forename: Dong Ha
authors.initials: DH
authors.lastname: Park
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Suwon, South Korea.
authors.forename: Hyun Suk
authors.initials: HS
authors.lastname: Song
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Suwon, South Korea. Electronic address: i00325@live.co.kr.
authors.forename: Il Jae
authors.initials: IJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D017130:Angioplasty; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply; D005684:Gait; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000601:surgery*; D011183:Postoperative Complications; D011300:Preoperative Care; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D014945:Wound Healing
keywords: Angioplasty; Free tissue flaps; Peripheral vascular disease