ABSTRACT
The technique of free-tissue transfer for complex wounds has become a common tool
in reconstructive surgery. The use of this modality in immunosuppressed transplant
patients, who often have associated metabolic and vascular disease, has not been well-documented.
The authors report three cases of lower-extremity reconstruction in renal-transplant
recipients, utilizing microvascular free-tissue transfer. All three patients were
hypertensive diabetic patients with symptomatic peripheral vascular disease and chronic
wounds. One patient presented with an exposed Achilles tendon; the second had a complex
wound of the forefoot; and the third patient had a large ulceration on the heel of
the right foot. These three patients underwent successful free-tissue transfer, and
have regained full use of their limbs and ambulation.
Free-tissue transfer in the immunosuppressed transplant recipient is a viable reconstructive
option. Careful perioperative metabolic monitoring and surgical care are critical
for success. A multispecialty approach is advocated, to coordinate limb salvage in
these patients.
