title: Endovascular revascularization and free tissue transfer for lower limb salvage.
abstract: Combined bypass surgery with free flap reconstruction is an established method for lower limb salvage. But the success of the combination of endovascular revascularization together with free tissue transfer has so far not been well established. A retrospective review of all patients who had undergone endovascular revascularization and reconstructed with free tissue transfer for lower limb salvage at Tzu Chi Dalin General Hospital between 2008 and 2012 was performed. A total of 26 legs underwent limb salvage in 24 patients. There were 10 male and 14 female patients. Their average age was 71.4 years. The average time interval between endovascular intervention and free tissue transfer was 8 days. There was 100% flap survival but partial flap necrosis was seen in three patients. A high rate of wound infection was seen in eight patients, all requiring further debridement. The total limb salvage rate at 1-year follow-up was 96% and 92% at the 2-year follow-up. In conclusion, the success rate of lower limb salvage using a combination of endovascular revascularization and free tissue reconstruction is comparable to using a combination of bypass surgery and free tissue transfer. It is associated with a high flap success rate and a high limb salvage rate. It provides physicians with a further treatment option in the management of ischemic lower limbs with extended tissue loss.
authors.affiliation: Division of Plastic Surgery, Tzu Chi Dalin General Hospital, Chiayi County, Taiwan; School of Medicine, Tzu Chi University, Hualien County, Taiwan.
authors.forename: Chieh-Chi
authors.initials: CC
authors.lastname: Huang
authors.affiliation: Division of Cardiovascular Surgery, Tzu Chi Dalin General Hospital, Chiayi County, Taiwan.
authors.forename: Chien-Hwa
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Division of Plastic Surgery, Tzu Chi Dalin General Hospital, Chiayi County, Taiwan; School of Medicine, Tzu Chi University, Hualien County, Taiwan. Electronic address: hondahsu@yahoo.com.tw.
authors.forename: Honda
authors.initials: H
authors.lastname: Hsu
authors.affiliation: Division of Plastic Surgery, Tzu Chi Dalin General Hospital, Chiayi County, Taiwan.
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Mark Chiu
authors.affiliation: Division of Plastic Surgery, Tzu Chi Dalin General Hospital, Chiayi County, Taiwan.
authors.forename: Chih-Ming
authors.initials: CM
authors.lastname: Lin
authors.affiliation: Division of Plastic Surgery, Tzu Chi Hualien General Hospital, Hualien, Taiwan.
authors.forename: Jiunn-Tat
authors.initials: JT
authors.lastname: Lee
authors.affiliation: School of Medicine, Tzu Chi University, Hualien County, Taiwan; Division of Plastic Surgery, Tzu Chi Taichung General Hospital, Taichung, Taiwan.
authors.forename: Sou-Hsin
authors.initials: SH
authors.lastname: Chien
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000379:methods*; D015897:Comorbidity; D003646:Debridement; D003925:Diabetic Angiopathies / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D007511:Ischemia / Q000601:surgery; D007866:Leg / Q000098:blood supply; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies
keywords: Angioplasty; Endovascular; Free tissue transfer; Lower limb salvage