Outcomes of Microvascular Reconstruction of Single-Vessel Lower Extremities: Limb Salvage versus Amputation
10 July 2009 (online)
Many patients with complex wounds on single-vessel lower extremities undergo amputation. Limb salvage using microvascular reconstructive techniques is an alternative in these patients that can preserve ambulatory status, but data focused on reconstruction in the single vessel population have been limited. A retrospective review of all microvascular lower-extremity reconstructions from August 2003 to December 2008 was performed. Forty-two patients were identified, of which 10 were found to have a complex wound and single-vessel perfusion to the affected extremity. Patient charts were reviewed for age, sex, medical comorbidities, mechanism of injury (traumatic versus nontraumatic), wound location, flap type, complications, flap outcome, and limb salvage outcome. All 10 flaps were successful (100%), and long-term limb salvage was 90%. Mean follow-up was 20.4 months. There were two complications, a hematoma and a case of flap success followed by reactivation of osteomyelitis 3 months after the free flap procedure resulting in below-knee amputation. The ultimate goal of limb salvage is to maximize limb length in an effort to prevent an increase in the energy of ambulation. Using microvascular reconstructive techniques, it can be performed successfully and with the majority of patients regaining an ambulatory status.
Limb salvage - single vessel - lower extremity
- 1 Moran S L, Illig K A, Green R M, Serletti J M. Free-tissue transfer in patients with peripheral vascular disease: a 10-year experience. Plast Reconstr Surg. 2002; 109 999-1006
- 2 Saddawi-Konefka D, Kim H M, Chung K C. A systematic review of outcomes and complications of reconstruction and amputation for type IIIB and IIIC fractures of the tibia. Plast Reconstr Surg. 2008; 122 1796-1805
- 3 Attinger C E, Ducic I.
Foot and ankle reconstruction. In: Thorne CH, Beasley RW, Aston SJ, Bartlett SP, Gurtner GC, Spear SL Grabb & Smith's Plastic Surgery. 6th ed. Philadelphia; Lippincott Williams & Wilkins 2007: 689-707
- 4 Spector J A, Levine S, Levine J P. Free tissue transfer to the lower extremity distal to the zone of injury: indications and outcomes over a 25-year experience. Plast Reconstr Surg. 2007; 120 952-959
- 5 Khouri R K, Shaw W W. Reconstruction of the lower extremity with microvascular free flaps: a 10-year experience with 304 consecutive cases. J Trauma. 1989; 29 1086-1094
- 6 Gonzalez M H, Tarandy D I, Troy D, Phillips D, Weinzweig N. Free tissue coverage of chronic traumatic wounds of the lower leg. Plast Reconstr Surg. 2002; 109 592-600
- 7 Hong J P. The use of supermicrosurgery in lower extremity reconstruction: the next step in evolution. Plast Reconstr Surg. 2009; 123 230-235
Ivica Ducic, M.D. , Ph.D.
Department of Plastic Surgery, Georgetown University Hospital
3800 Reservoir Road N.W., Washington, DC 20007