Abstract
Microvascular flap reconstruction surgery is a limb preservation procedure performed
in an effort to maintain the integrity of the lower limb and avoid amputations. Individuals
facing the prospect of amputation often have long-term diabetes with multiple comorbidities,
including severe peripheral vascular disease; peripheral arterial disease; chronic
ulcerations; and Charcot arthropathy. Long-term clinical research has shown that these
patients are at much higher risk for secondary amputations after a first amputation
is performed. According to Sohn et al, Charcot and ulcer groups had 4.1 and 4.7 amputations
per 100 person-years, respectively. In patients younger than 65 years old at the end
of follow-up, amputation risk, relative to patients with Charcot alone, was 7 times
higher for patients with ulcer alone and 12 times higher for patients with Charcot
and ulcer. Patients with infected hardware, suffering from acute ulcerative conditions,
may also be candidates for this type of surgery due to extensive tissue loss secondary
to infection. Microvascular flap reconstruction surgery is a highly technical surgery
involving the use of orthoplastic techniques, which is performed under ×3.5 loupe
magnification. Due to the inability to perform this procedure with the use of a tourniquet,
visibility within the field is obfuscated from continuous blood flow along the dissected
muscle belly. Hydrogen peroxide (H2O2) is an excellent alternative to tourniquet use. The use of H2O2 allows additional benefits, such as visual field clearance and antisepsis.
Keywords
hydrogen peroxide - hemostasis - embolization
