THE LIMITED VALUE OF PREOPERATIVE ANGIOGRAPHY IN MICROSURGICAL RECONSTRUCTION OF THE LOWER-LIMB

Biplanar angiography has been a prerequisite in microvascular reconstr uction of the lower extremity. While defining arterial anatomy, the pr ocedure is not without morbidity. More important, angiography does not determine the acceptability of arterial blood flow through a particul ar recipient vessel. The purpose of this study was to evaluate the saf ety of microvascular tissue transplantation for reconstruction of comp lex lower-limb wounds, without preoperative angiography. A consecutive series of 48 patients undergoing tissue transplantation for complex w ound 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 t rauma. Preoperative and intraoperative clinical assessment of recipien t vessels allowed successful reconstruction in all but one case. The o nly loss of a transplant arose as a result of venous outflow obstructi on, a situation not to be improved by preoperative angiography. In no instance was a patient explored and reconstruction deferred due to ina dequate recipient vasculature. The results of this study support micro vascular tissue transplantation to lower-limb wounds without preparato ry angiography in almost all circumstances. Adequate clinical paramete rs are presented for determining recipient pedicle status, both preope ratively and intraoperatively.