ABSTRACT
Biplanar angiography has been a prerequisite in microvascular reconstruction of the
lower extremity. While defining arterial anatomy, the procedure is not without morbidity.
More important, angiography does not determine the acceptability of arterial blood
flow through a particular recipient vessel. The purpose of this study was to evaluate
the safety of microvascular tissue transplantation for reconstruction of complex lower-limb
wounds, without preoperative angiography. A consecutive series of 48 patients undergoing
tissue transplantation for complex wound reconstruction during a recent 8-month period
is presented. Sixty percent of patients had soft-tissue wounds classified as Gustilo
IIIB preoperatively, although 89 percent of wounds ultimately arose from trauma. Preoperative
and intraoperative clinical assessment of recipient vessels allowed successful reconstruction
in all but one case. The only loss of a transplant arose as a result of venous outflow
obstruction, a situation not to be improved by preoperative angiography. In no instance
was a patient explored and reconstruction deferred due to inadequate recipient vasculature.
The results of this study support microvascular tissue transplantation to lower-limb
wounds without preparatory angiography in almost all circumstances. Adequate clinical
parameters are presented for determining recipient pedicle status, both preoperatively
and intraoperatively.
