title: Free tissue transfer after targeted endovascular reperfusion for complex lower extremity reconstruction: setting the stage for success in the presence of mutlivessel disease.
abstract: Recent advances in both microsurgical and endovascular techniques have redefined our approach to complex lower extremity reconstruction in high-risk patients with multivessel disease. When used as an adjunct to free tissue transfer, targeted endovascular therapy has been suggested to optimize recipient-site hemodynamics and promote flap survival in regions of compromised distal blood flow. With a paucity of published outcomes to support this approach, however, the perceived benefits derived from adjunctive endovascular therapy remain largely anecdotal. In this report, we present the outcomes and complications for 3 patients in whom preoperative endovascular therapy was used to improve both direct and collateral distal perfusion and recipient-vessel caliber. Flap survival in this series was 100%, and all patients remained ambulatory at a mean final follow-up of 24.7 months. Minor flap necrosis, necessitating debridement and skin grafting, was seen in one patient, who ultimately required a contralateral below-knee amputation secondary to nonsalvageable arterial disease. All patients were satisfied with respect to pain, function, and cosmetic appearance. On the basis of our experience and previously reported cases, we advocate a role for prereconstructive endovascular therapy as part of a multidisciplinary approach to functional limb salvage in patients with advanced arterial disease.
authors.affiliation: Department of Plastic Surgery, Center for Wound Healing, Medstar Georgetown University Hospital, Washington, DC.
authors.forename: Michael V
authors.initials: MV
authors.lastname: DeFazio
authors.affiliation: Department of Plastic Surgery, Center for Wound Healing, Medstar Georgetown University Hospital, Washington, DC.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Han
authors.affiliation: Department of Plastic Surgery, Center for Wound Healing, Medstar Georgetown University Hospital, Washington, DC.
authors.forename: Cameron M
authors.initials: CM
authors.lastname: Akbari
authors.affiliation: Department of Plastic Surgery, Center for Wound Healing, Medstar Georgetown University Hospital, Washington, DC. Electronic address: karen.k.evans@gunet.georgetown.edu.
authors.forename: Karen K
authors.initials: KK
authors.lastname: Evans
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon; D003097:Collateral Circulation; D003131:Combined Modality Therapy; D058752:Free Tissue Flaps; D006801:Humans; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D019651:Plastic Surgery Procedures; D012039:Regional Blood Flow; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency