LIMB SALVAGE AND WOUND COVERAGE IN PATIENTS WITH LARGE ISCHEMIC ULCERS - A MULTIDISCIPLINARY APPROACH WITH REVASCULARIZATION AND FREE TISSUE TRANSFER

Purpose: Large ischemic wounds, particularly with exposed bone or tend ons, may not heal even after successful revascularization. We have tak en an aggressive approach for limb salvage that uses autogenous vein g rafting and simultaneous microvascular free tissue transfer. Methods: In the past year, seven patients (average age 67 years; range 56 to 79 ) with ischemic disease and distal ulceration underwent revascularizat ion for limb salvage and free tissue transfer. Each had a nonhealing w ound (average size 80 cm2), present for 8.6 months (range 2 to 24 mont hs). Simultaneous vein bypass and free tissue transfer was performed i n four (57%) of the seven patients. Results: All flaps were initially viable; however, one was lost on day 4 because of hypotension and cong estive heart failure. One patient with a successful flap died at 1 mon th of pneumonia. Minor wound complications were seen in four (57%) of seven patients. Five of the seven patients had the wounds heal complet ely and are ambulatory at an average follow up of 10 months. Conclusio ns: Our aggressive approach was successful in preserving limb length a nd function in 71% of our patients. We perform simultaneous procedures whenever possible to minimize operative and hospitalization times. We believe that this combined approach optimizes the treatment of ischem ic limbs with large ulcers.