title: [Reconstruction of the vascular compromised lower extremity - report of the consensus workshop at the 35. Meeting of the DAM (Deutschsprachige Gemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße) 2013 in Deidesheim].
abstract: BACKGROUND
  As microsurgical reconstruction is now being increasingly performed on patients with critical peripheral perfusion and/or arterial occlusive disease in numerous centres, there is a need for standardisation of interdisciplinary diagnostic approach and treatment regimens in such critically ill patients. In a consensus workshop on reconstruction of the vascular compromised lower extremity during the 35th Annual Meeting of the German working group microsurgery of the peripheral nerves and vessels (DAM) in 2013 in Deidesheim, DAM members together with vascular surgeons and interventional radiologists attempted to establish interdisciplinarily routine pathways for diagnosis and therapy and to consolidate key recommendations for treatment.
  
  
  METHODS
  By reviewing the literature and considering the results of the expert meetings, options and limits of therapy were illustrated and recommendations for successful cooperative treatment formulated.
  
  
  RESULTS
  By means of interdisciplinary cooperation, limbs can be salvaged and the quality of live as well as survival of patients with severe peripheral vascular disease improved. Different techniques including angioplasty, bypass surgery and microsurgical free flaps can be applied and individualised concepts allow extremity salvage even in patients with severely compromised limbs. Revascularisation provides the possibility of free flap transfer while the risk for the patients is moderate.
  
  
  CONCLUSIONS
  The poor general condition of the patient requires a sufficient interdisciplinary preoperative planning. By means of interdisciplinary cooperation, the limbs can be salvaged. This not only improves the quality of life but also increases the survival time of patients with occlusive vascular disease. Different concepts for this group of patients have been developed. Surgical treatment with a distal bypass or recanalisation and free flap not only allow for the coverage of large defects, but also represent a haemodynamic advantage by increased blood flow in the bypass. This is attributed to the additional vascular bed that is transplanted with the free flap. Limb salvage means relevant improvement, however, the initially less demanding procedure of amputation must always be considered.
authors.affiliation: Klinik für Plastische Chirurgie und Schwerbrandverletzte, Handchirurgiezentrum Operatives Referenzzentrum für Gliedmaßentumoren, BG-Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bochum.
authors.forename: A
authors.initials: A
authors.lastname: Daigeler
authors.affiliation: Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG-Unfallklinik Ludwigshafen, Klinik für Plastische Chirurgie und Handchirurgie an der Rupprecht-Karls-Universität Heidelberg, Ludwigshafen.
authors.forename: U
authors.initials: U
authors.lastname: Kneser
authors.affiliation: Heitmann und Fansa - Ästhetisch Plastische Chirurgie, Gemeinschaftspraxis für Plastisch Ästhetische Chirurgie, München.
authors.forename: H
authors.initials: H
authors.lastname: Fansa
authors.affiliation: Chirurgische Klinik, Gefäßchirurgie, Universitätsklinikum Mannheim, -Universitätsmedizin Mannheim, Mannheim.
authors.forename: T
authors.initials: T
authors.lastname: Riester
authors.affiliation: Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen.
authors.forename: M
authors.initials: M
authors.lastname: Uder
authors.affiliation: Universitätsklinikum Erlangen, Plastische und Handchirurgie, Erlangen.
authors.forename: R E
authors.initials: RE
authors.lastname: Horch
mesh_terms: D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000601:surgery*; D003299:Cooperative Behavior; D016638:Critical Illness; D058752:Free Tissue Flaps / Q000098:blood supply / Q000294:innervation / Q000601:surgery; D005858:Germany; D006801:Humans; D033183:Interdisciplinary Communication; D007511:Ischemia / Q000175:diagnosis / Q000601:surgery*; D007866:Leg / Q000098:blood supply* / Q000294:innervation; D008866:Microsurgery / Q000379:methods*; D010525:Peripheral Nerves / Q000601:surgery; D012955:Societies, Medical