Combined revascularization and microvascular free tissue transfer for limbsalvage: A six-year experience

Atherosclerotic vascular disease causing extensive tissue loss of the lower extremities often results in primary amputation. Combined revascularizatio n and free tissue transfer has been described as a method of extending limb salvage to these patients. The durability of this combined procedure remai ns unknown, thus the objective of this report is to describe the immediate and long-term results in a series collected over 6 years. From 1992 to 1998 , 15 patients with a mean age of 60 years underwent combined revascularizat ion and free tissue transfer. Mean ulcer size measured 45 cm(2) for a mean duration of 7.4 months preoperatively and 12 patients had exposed bone or t endon. Vascular reconstruction included popliteal (3), tibial (6), and peda l (6) bypass with concomitant myocutaneous free flap, using mostly rectus a bdominis or latissimus dorsi muscle. There were no perioperative deaths. On e patient suffered a nonfatal myocardial infarction. Two patients had a pos toperative wound hematoma and one required vascular graft revision. Patient s were followed for 4 to 75 months (mean = 23 months). Four patients have r equired amputations (3 early, 1 late), three of whom had preoperative renal failure. The limb salvage rate has been 72% at 36 months, with 10 of 11 pa tients having functional ambulation. Combined revascularization and free ti ssue transfer is safe and durable, and long-term limb salvage is obtainable . Patients with renal failure had poorer outcomes in this series.