Download PDF
J Reconstr Microsurg 2009; 25(8): 475-478
DOI: 10.1055/s-0029-1225536
© Thieme Medical Publishers

Outcomes of Microvascular Reconstruction of Single-Vessel Lower Extremities: Limb Salvage versus Amputation

Ivica Ducic1 , Samir S. Rao1 , Christopher E. Attinger1
  • 1Department of Plastic Surgery, Georgetown University Hospital, Washington, DC
Further Information

Publication History

Publication Date:
10 July 2009 (online)

    Permissions and Reprints

ABSTRACT

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.

KEYWORDS

Limb salvage - single vessel - lower extremity

REFERENCES

  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 7 Hong J P. The use of supermicrosurgery in lower extremity reconstruction: the next step in evolution.  Plast Reconstr Surg. 2009;  123 230-235
    CrossrefPubMedGoogle Scholar

Ivica DucicM.D. Ph.D. 

Department of Plastic Surgery, Georgetown University Hospital

3800 Reservoir Road N.W., Washington, DC 20007

Email: ducici@gunet.georgetown.edu

      >