EXTENSION OF LIMB SALVAGE BY COMBINED VASCULAR RECONSTRUCTION AND ADJUNCTIVE FREE-TISSUE TRANSFER

Purpose: Vascular reconstruction alone can be insufficient for extremi ty salvage in some patients with severe soft-tissue wounds. We present our experience in 20 patients with vascular reconstruction for ischem ic disease and free-tissue transfer for limb-threatening soft-tissue w ounds. Methods: Nineteen patients underwent autogenous venous bypasses and one patient underwent an aortobifemoral bypass. Ten soft-tissue r econstructions were performed at the time of the vascular reconstructi on and 10 were delayed. Free-tissue transferred included muscle, fasci ocutaneous flaps, and omentum. Inflow to the flap was from the bypass graft (n = 12) or the distal tibial artery. Results: One free flap and graft failed immediately in the same patient. One successful flap and graft required a below-knee amputation for ongoing infection in the s urrounding soft tissues. Eighteen of 20 patients have had free-flap an d graft patency during the mean follow-up period of 17 months (range 6 to 33 months). These 18 patients ambulate independently. Conclusions: In patients with arterial insufficiency and severe soft-tissue wounds , combined vascular reconstruction and free-tissue transfer permits ex tended limb salvage with excellent functional results.