Management of hypovascularized wounds not responding to conventional therapy by means of free muscle transplantation

Background: Chronic ulceration as a complication of arteriosclerotic diseas e, venous congestion or diabetes mellitus is still a serious clinical probl em, resulting in immobilization, extended hospitalization and cost-intensiv e treatment. Other than standard conservative treatment protocols or early amputation, microsurgical free transfer of well vascularized muscle tissue onto chronic wounds can induce angiogenesis and improve wound healing even in the hypovascularized wound. Patients: From 1993-1999 ive treated 12 patients (mean age: 46 years) with vascular ulcers of the lower extremity with free muscle or fasciocutaneous tissue transfer Results: The average hospitalization was 51.4 days. The perioperative morta lity was zero. In one patient with factor V deficiency a partial flap necro sis occurred. Two revisions of the micro anastomoses had to be performed. T wo seromas occurred at the donor site. No secondary flap loss was observed. Extremity or stump length preservation was achieved in all cases. Conclusions: Optimal postoperative treatment with physiotherapy and orthopa edic shoe support is important. If all these factors are present and if the patient is highly motivated a reintegration into normal life can be achiev ed.