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Free Tissue Transfer Combined With Distal Revascularization

Jack L. Cronenwett, MD; Martha D. McDaniel, MD; Robert M. Zwolak, MD, PhD; Daniel B. Walsh, MD; Joseph R. Schneider, MD; William F. Reus, MD; Lawrence B. Colen, MD

Arch Surg. 1989;124(5):609-615.

Abstract
• Extensive lower-extremity tissue loss may preclude limb salvage despite successful arterial reconstruction. We attempted to avoid limb loss in such patients by combining arterial bypass with microvascular free tissue transfer. Fourteen patient (12 diabetic), 33 to 74 years of age, presented with extensive tissue loss in 15 lower extremities, exposing bone or tendon on the heel, ankle, lower part of the leg, or hindfoot. Mean ulcer size was 5x8 cm. Four patients had had previous contralateral below-knee amputations. Femorodistal (seven), popliteal-distal (three), or femoropopliteal (four) bypass, or tibial angioplasty (one), was perfomed to provide sufficient inflow for free tissue tranfer. Serratus anterior, scapular, latissimus dorsi, rectus abdominis, gracilis, ulnar, or temporalis free flaps were used. One free flap failed due to venous thrombosis and was corrected with a second flap. Limb salvage was achieved in 14 (93%) of 15 limbs during a mean follow-up of 24 months. The single amputation occurred due to severe foot ischemia in a patient whose femorodistal bypass remained patent only to the viable free flap. The remaining 13 patients (14 limbs) became ambulatory, including those with free flaps to weight-bearing regions.

(Arch Surg. 1989;124:609-615)

Author Affiliations
From the Sections of Vascular (Drs Cronenwett, McDaniel, Zwolak, Walsh, and Schneider) and Plastic (Drs Reus and Colen) Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Hanover, NH, and Veterans Administration Medical Center, White River Junction, Vt.

Footnotes
Accepted for publication December 20, 1988.

Read before the 69th Annual Meeting of the New England Surgical Society, Montreal, Canada, September 16, 1988.

Reprint requests to Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Hanover, NH 03756 (Dr Cronenwett).

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