A 15-Year Experience with Combined Vascular Reconstruction and Free Flap Transfer for Limb-Salvage

Abstract

recorded. ABI Ͻ 0.9 was considered equivalent to moderate-to-high CHD risk (Ն10%).Results: ABI Ͻ 0.9 prevalence was 4.5%. Only 0.62% presented low ABI and IC. Age, current smoker, cardiovascular disease, and uncontrolled hypertension independently associated with ABI Ͻ 0.9 in both sexes; IC was also associated in men and diabetes in women. Among participants 35-74 free of cardiovascular disease, 6.1% showed moderate-to-high 10-year CHD risk; adding ABI measurement yielded 8.7%. Conversely, the risk function identified 16.8% of these participants as having 10-year CHD risk Ͼ 10%. In participants 75-79 free of cardiovascular disease, the prevalence of ABI Ͻ 0.9 (i.e., CHD risk Ն 10%) was 11.9%.Conclusions: ABI Ͻ 0.9 is relatively frequent in those 35-79, particularly over 74. However, IC and CHD risk Ն 10% indicators are often missing. Adding ABI measurement to CHD-risk screening better identifies moderate-to-high cardiovascular risk patients. Objectives:The aim of this study was to determine accurate estimates of the success rate of subintimal angioplasty in terms of ability to recanalise occluded vessels, patency over time and limb salvage rates.Design: A meta-analysis of published literature. Materials:All studies reporting unique patient data published in English language between 1989 and 2008.Methods: Separate meta-analyses were performed for immediate technical success, 12-month patency rates and 12-month limb salvage rates. Longer-term outcomes were analyzed in separate meta-analyses. Metaregression was applied to determine whether any of these outcomes had improved over time.Results: Pooled estimates for technical success, primary patency at 12 months and limb salvage at 12 months were 85.7% (95% confidence interval: 83.3%-87.7%, 2810 limbs), 55.8% (95% confidence interval: 47.9%-63.4%, 1342 limbs), and 89.3% (95% confidence interval: 85.5%-92.2%, 2810 limbs), respectively. Regression analysis demonstrated no significant change in outcomes over time. There was some evidence of publication bias, however, after adjusting for this there was little change in the pooled outcome estimates.Conclusions: This study demonstrates that the outcomes for subintimal angioplasty are good and that this method should be considered as an alternative to surgical bypass.

Free flaps for reconstruction of soft tissue defects in lower extremity: A meta‐analysis on microsurgical outcome and safety

“…Therefore, these three articles were additionally excluded. Finally, 30 articles overlooking 1,356 patients and 1,397 free flaps for lower extremity reconstruction were included in the present meta‐analysis (Table ) …”

Vascular considerations in foot and ankle free tissue transfer: Analysis of 231 free flaps

“…Free tissue transfer in conjunction with direct surgical revascularization, whether staged or simultaneous, has become an accepted form of treatment for patients with severe distal disease, limb‐threatening ischemia, and otherwise non‐reconstructible arterial occlusive disease and soft tissue loss . Patients otherwise destined for leg amputation may achieve reliable limb salvage following arterial reconstruction and free flap coverage . Nevertheless, the combination of free tissue transfer and arterial bypass grafting for ischemic lower extremity wounds has been shown to be a high‐risk and complex procedure with poor long‐term success in patients with diabetes and end‐stage renal disease .…”

“…17,18 Patients otherwise destined for leg amputation may achieve reliable limb salvage following arterial reconstruction and free flap coverage. 29,30 Nevertheless, the combination of free tissue transfer and arterial bypass grafting for ischemic lower extremity wounds has been shown to be a high-risk and complex procedure with poor long-term success in patients with diabetes and end-stage renal disease. 18,30 Detailed knowledge of arterial vessel predominance and directional flow in these complex wounds can guide the plastic and vascular surgeons in designing the best reconstructive and revascularization treatment strategies.…”

Soft Tissue Reconstruction

“…12 Oh et al have also reported that, 6 in their series of 113 diabetics, who underwent successful free flap transfer for foot ulcerations, the patients had a higher 5-year survival rate compared with those who were not treated. Most studies today would agree that despite the potential costs of limb salvage, it is still far cheaper compared with the costs of multiple unsuccessful local flaps and eventual amputation.…”

“…Although this type of surgery is technically challenging compared with most other free flap transfers, it can be successful and very rewarding in terms of limb salvage in the affected patients. 12 Further, in 2010, Kim suggested that perforator flaps using "supermicrosurgery" could be successfully performed in these patients, perhaps obviating the need for an open major vessel for anastomosis. 2 We did, however, note that the complication rate was fairly high, but this was mostly limited to wound-healing issues.…”