Free tissue transfer to extend the limits of limb salvage for lower extremity tissue loss

Tibial bone loss and soft-tissue defect treated simultaneously with Ilizarov-technique--a case report

“…The only other alternative to close the soft-tissue defect would be the use of a free muscle flap, which is technically demanding, but a reliable solution (Gooden et al 1997). An alternative treatment of the defect in the extensor muscles and anterior tibial tendons could have been a tendon transplant (Hahn and Kim 1991).…”

Infection-Related Exposure of the Lower Anastomosis of Femorodistal Bypass: Salvage through Use of Pedicle Muscle Flaps

“…Numerous reports have documented the value of conservative treatment, 2,5,7-10 which usually consists of local treatment, i.e., removal of necrotic tissue, damp dressing, and antibiotic therapy. [9][10][11][12][13][14][15][16][17][18] Extensive debridement can result in major tissue loss, exposing the infected anastomosis and placing it at risk of rupture. In both animal experiments 22 and clinical trials, 17 various types of flaps, especially muscle flaps, 21 have been successfully used for treatment of localized prosthetic vascular graft infection; this is probably due to increased diffusion of antibiotics.…”

“…11 Conservative treatment usually consists of local debridement, with or without subsequent by grafting. 2,5,7,9 Free flaps have been used in association with distal bypass in patients with extensive lower extremity tissue defects [12][13][14] but have rarely been used for coverage of exposed anastomoses. 15 Pedicle muscle flaps have been used to cover anastomoses at the femoral triangle, 8,[16][17][18] but most plastic surgeons contraindicate use of distal pedicle flaps in patients with arterial disease because of risk of hypovascularization and flap necrosis.…”

Blood flow in free micro-vascular flaps

“…Different types of free flap (omental (100), fasciocutaneous (48,145), myocutaneous (123) and muscle (87,182)) have been used together with autogenous vein grafts in critical leg ischaemia patients to cover the bypass and soft tissue defect in an effort to avoid major amputation. A report also exists of the successful use of a free rectus abdominis muscle flap in combination with a long polytetrafluoroethylene bypass in a 69-year-old patient (71).…”

“…A report also exists of the successful use of a free rectus abdominis muscle flap in combination with a long polytetrafluoroethylene bypass in a 69-year-old patient (71). Although the leg salvage rate in operations by this technique ranges from 70 % to 90 % (48,87,147), the effect of a free muscle flap on the haemodynamics of the recipient bypass and recipient site remains controversial. In a series of 30 lower limb revascularizations with simultaneous free flap transfers, Tukiainen et al observed three cases of long-term leg salvage despite free flap failure (unpublished).…”