Advanced Leg Salvage of the Critically Ischemic Leg With Major Tissue Loss by Vascular and Plastic Surgeon Teamwork

Tukiainen, Erkki; Kallio, Milla; Lepäntalo, Mauri

doi:10.1097/01.sla.0000247985.45541.e8

Cited by 85 publications

(89 citation statements)

References 22 publications

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“…Teamwork between vascular and plastic surgeons is essential in this delicate surgery and in preoperative, perioperative and postoperative care, including experts from other disciplines as well. 2) The concept of distal revascularization and FTT is supported by several studies, which have reported a primary patency rate of 86%. 11) However, graft patency is not absolutely necessary for flap survival.…”

Section: Discussionmentioning

confidence: 65%

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Combined Arterial Reconstruction and Free Tissue Transfer for Patients with Critical Limb Ischemia

Igari

Kudo

Toyofuku

et al. 2013

Annals of Vascular Diseases

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Section: Discussionmentioning

confidence: 65%

“…Four patients remained free from arterial revascularization-related complications after achieving wound healing. The postoperative values of tcPO 2 were elevated in all cases.…”

Section: Resultsmentioning

confidence: 82%

Combined Arterial Reconstruction and Free Tissue Transfer for Patients with Critical Limb Ischemia

Igari

Kudo

Toyofuku

et al. 2013

Annals of Vascular Diseases

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“…the number of patients in our series is relatively small. However, there are only four studies on this issue with large patient population (14,15,20,21). All others report the number of patients to be 9-26 (12).…”

Section: Discussionmentioning

confidence: 99%

“…nevertheless, none of the patients in our study would have gained complete wound healing with conservative methods as is the situation with some cLI patients (23). In many centers, free flap candidates are evaluated and treated through a collaborative effort of the vascular and plastic surgical services (12,14,21,24). Fizgerald o'connor et al (12) report in their systematic review of free tissue transfer that 66% patients had concomitant revascularization with bypass surgery and 3,8% angioplasty.…”

Section: Discussionmentioning

confidence: 99%

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Successful foot salvage with microvascular flaps in diabetic patients

et al. 2014

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Background and Aims: Complex nontraumatic foot lesions often lead to major lower-limb amputation in diabetic patients. We aimed to evaluate outcome of free flap transfer in such cases. Materials and Methods: A total of 11 consecutive diabetic patients, hospitalized between 2007 and 2012 at a university central hospital for a free flap transfer, were followed until September 2013. Amputation-free survival, patient survival, and complete wound healing were defined as primary endpoints. Healing time of tissue lesions was analyzed. All pre- and postoperative data were retrospectively collected from hospital charts. Results: Complete tissue healing at 6 and 12 months after free flap transfer were 55% (6/11) and 82% (9/11), respectively. The median time to complete tissue healing was 123 days (range, 45–207 days). Overall limb salvage, survival, and amputation-free survival rates at 12 months were 90%, 91%, and 82%, respectively. The clinically important endpoint, namely, amputation-free survival with completely healed wounds, was attained in 9 of 11 patients at 1 year. Conclusion: Free tissue transfer enables successful wound healing and limb salvage rather than amputation in selected diabetic patients with difficult-to-heal wounds. Complete healing of tissue lesions is slow even after successful surgery. Preoperative assessment of the condition of patients is the key to success.

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Surgical revascularization and reconstruction procedures in diabetic foot ulceration

Houlind

2019

Diabetes Metabolism Res

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This article summarizes surgical procedures for preservation of the foot in diabetic patients with peripheral artery disease. Distal bypass surgery performed to perigeniculate arteries and to an isolated ‘blind’ popliteal segment with visible collaterals can be performed with limb salvage rates close to what can be achieved with standard bypass to crural arteries. This is also the case when performing bypass to the dorsalis pedis artery. Bypass to the medial or lateral plantar artery or to the lateral tarsal artery is associated with a relatively high rate of early occlusion, but in the patients who have persistently open grafts, limb salvage is common. The use of an arteriovenous fistula as an adjunct to distal bypass surgery does not improve prognosis. Venous arterialization, either creating retrograde perfusion of the superficial or of the deep veins of the foot has been successful in several cases although it is difficult to predict which patients will benefit. Reconstructive surgery is often performed in a multidisciplinary team including plastic surgeons. In patients with need of more extensive cover of defects, the transplant of muscular or fasciocutaneous free flaps has provided good results in the few centres that have applied this technique. This procedure can be combined with a revascularization in the same session or at a later stage. A majority of the described techniques can be implemented in most vascular centres and they should be considered in complicated cases when standard methods of revascularization and reconstruction do not suffice.

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Advanced Leg Salvage of the Critically Ischemic Leg With Major Tissue Loss by Vascular and Plastic Surgeon Teamwork

Cited by 85 publications

References 22 publications

Combined Arterial Reconstruction and Free Tissue Transfer for Patients with Critical Limb Ischemia

Combined Arterial Reconstruction and Free Tissue Transfer for Patients with Critical Limb Ischemia

Successful foot salvage with microvascular flaps in diabetic patients

Surgical revascularization and reconstruction procedures in diabetic foot ulceration

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