Arteriovenous loops, vascular bypasses, and inflow augmentation: Enhancing limb salvage through collaboration and microsurgical creativity

Abstract

Limb-threatening extremity defects resulting from high-energy trauma, chronic ischemia, infection, or oncologic resection are frequently associated with a “zone of injury” devoid of suitable recipient vessels, thereby precluding conventional free tissue transfer reconstruction. In this review article, we summarize five decades of technical development and clinical evidence on advanced microsurgical strategies – such as arteriovenous (AV) loops, vascular bypasses, and nutrient flaps – aimed at restoring vascular continuity and enabling durable soft tissue coverage when local anastomosis is precluded. Regardless of the technique employed, meticulous microsurgical execution, thoughtful staging, and interdisciplinary collaboration among plastic, orthopedic, and vascular surgeons are critical to achieving optimal outcomes. Collectively, these strategies provide a versatile, evidence-based armamentarium that enables reconstructive surgeons to preserve limb length, secure durable soft tissue coverage, and restore meaningful function to extremities once considered unsalvageable.

Zusammenfassung

Extremitätenbedrohende Defekte, verursacht durch Hochenergie-Trauma, chronische Ischämie, Infektionen oder onkologische Resektionen, gehen häufig mit einer „Verletzungszone“ einher, die keine geeigneten Empfängergefäße aufweist und eine konventionelle Rekonstruktion mittels freiem Gewebetransfer unmöglich macht. In diesem Übersichtsartikel fassen wir fünf Jahrzehnte technischer Entwicklungen und klinischer Evidenz zu fortgeschrittenen mikrochirurgischen Strategien zusammen – darunter arteriovenöse (AV) Schleifen, Gefäßbypässe und nutritive Lappenplastiken –, die der Wiederherstellung der Gefäßkontinuität und der dauerhaften Weichteildeckung dienen, wenn eine lokale Anastomose nicht möglich ist. Unabhängig von der gewählten Technik sind präzise mikrochirurgische Ausführung, durchdachte Operationsplanung in mehreren Phasen sowie die interdisziplinäre Zusammenarbeit zwischen plastischen, orthopädischen und gefäßchirurgischen Fachdisziplinen entscheidend für ein optimales Ergebnis. Zusammengenommen stellen diese Strategien ein vielseitiges, evidenzbasiertes Instrumentarium dar, das es rekonstruktiven Chirurgen ermöglicht, die Extremitätenlänge zu erhalten, eine stabile Weichteildeckung zu erreichen und eine funktionelle Wiederherstellung zu erzielen.

Keywords

orthoplastic - arteriovenous loop - bypass - limb salvage

Schlüsselwörter

orthoplastisch - arteriovenöse Gefäßschleife - Bypass - Extremitätenerhalt

Publikationsverlauf

Eingereicht: 29. April 2025

Angenommen: 01. Juli 2025

Artikel online veröffentlicht:
29. September 2025

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