Free Vascularized Tissue Transfer for Limb Salvage in Peripheral Vascular Disease

Greenwald, Lori L.; Comerota, Anthony J.; Mitra, Amit; Grosh, Julieta D.; White, John V.

doi:10.1007/bf02009452

Cited by 26 publications

(14 citation statements)

References 24 publications

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“…Preoperative angiography has been described and recommended by previous studies to evaluate vascular occlusion in the original lower extremity and detect adequate anastomotic vessels (Greenwald, Comerota, Mitra, Grosh, & White, ; Mimoun, Hilligot, & Baux, ). Vessel‐selective angiography is the most suitable approach for providing a detailed assessment of the postoperative hemodynamic status of an ischemic limb and transferred flap, though there are a number of other examinations including noninvasive Doppler pulse volume recording, vascular ultrasonography, computed tomographic angiography, and magnetic resonance angiography.…”

Section: Discussionmentioning

confidence: 99%

“…An operative procedure combining free tissue transfer and a distal bypass graft, which was first described by Briggs et al in 1985 (Briggs, Banis, Kaebnick, Silverberg, & Acland, ), is widely performed in the treatment of CLI patients. The treatment outcomes have recently been reported by a number of institutions (Czerny et al, ; Greenwald, Comerota, Mitra, Grosh, & White, ; Horch et al, ; Igari et al, ; Illig et al, ; Kolbenschlag, Hellmich, Germann, & Megerle, ; Meyer et al, ; Randon, Jacobs, De Ryck, Van Landuyt, & Vermassen, ; Serletti et al, ; Tukiainen, Kallio, & Lepäntalo, ), and the effectiveness of this combined plastic and vascular surgical approach for limb salvage was considered to already be established in selected patients. Mimoun et al reported about the “nutrient flap” concept in 1989 that the transferred flap provides a supplementary blood supply and induces a new capillary bed at the ischemic region of its implantation, with its skin‐covering role being accessory (Mimoun, Hilligot, & Baux, ).…”

Section: Introductionmentioning

confidence: 94%

See 1 more Smart Citation

The possibility of free tissue transfer as a nutrient flap for critical ischemic foot: A case report

et al. 2017

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Microsurgical procedure of free tissue transfer in critical limb ischemia patients with large ulceration has already been established. The nutrient flap concept was that transferred tissue functioned not only to cover the skin defect but also as a supplementary blood supply to the ischemic lower leg. This report showed the justification for this concept, which was rarely discussed. A 58-year-old male patient with progressive forefoot gangrene caused by arteriosclerosis obliterans was presented. The distal bypass procedure was performed as revascularization surgery, and a latissimus dorsi (LD) myocutaneous flap was transplanted to cover ulceration. The arterial pedicle of the flap was anastomosed to the vein graft in an end-to-end manner, and the venous pedicle was anastomosed to the posterior tibialis vein in an end-to-end manner. Bypass graft blood flow went straight to the LD flap only. The postoperative course was uneventful. The free flap and right foot survived successfully and the patient was ambulatory with no recurrence of ulceration wearing order-made shoes more than three years after transplantation. Vessel-selective angiography was performed two months after surgery. An angiographic catheter was inserted into the bypass graft, which ran straight through the flap nutrient artery. The results obtained showed that not only the transferred flap area, but also the remaining original foot soft tissue (including the sole and heel) was clearly visualized radiologically only through the flap nutrient vessel. This findings of the angiography appear to provide direct evidence for the nutrient flap concept.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

The possibility of free tissue transfer as a nutrient flap for critical ischemic foot: A case report

et al. 2017

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“…76 Many other studies have shown that prior treatment with radiation therapy does not affect the incidence of flap complications (Level II Evidence) 8,19,25,30,31 but was found to increase postoperative wound dehiscence in bilateral DIEP flap patients (Level II Evidence). 60 However, in the historic 1998 multicenter prospective study of 493 free flaps, Khouri et al demonstrated that irradiated recipient sites predicted higher flap failure rates (Level I Evidence).…”

Section: Radiation Therapymentioning

confidence: 97%

“…Free flaps play a critical role in limb salvage in the face of severe peripheral vascular disease for chronic wounds, extensive soft-tissue defects, exposed tendons, and bone that would otherwise require amputation. 76,77 Free flaps may provide increased venous drainage and supplemental blood flow to hypoxic areas, and augments angiogenesis. 78 Amputations are associated with 24 percent mortality after 6 months.…”

Section: Peripheral Vascular Diseasementioning

confidence: 99%

Evidence to Support Controversy in Microsurgery

Fan

Patel

Mardini

et al. 2015

Plastic and Reconstructive Surgery

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Microsurgery practice, including preoperative patient selection, intraoperative technique, and anesthetic considerations, varies from institution to institution and from surgeon to surgeon. Many surgeons' practices are driven by "conventional wisdom," which is handed down from mentors to fellows and residents. In this article, the authors explore the oxymoron that there is evidence to support controversy in microsurgery. Indeed, if there was convincing evidence to support varying microsurgery practices, there would be no controversy. The authors conducted a review with a focus on evidence-based medicine to support microsurgery practice.

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“…Free flap reconstruction offers wound coverage but does not improve the distal circulation. However, there are reports of revascularisation of critical limb ischaemic wounds with free flap coverage being offered as a single procedure with reasonable results [ 13 , 14 ].…”

Section: Reconstruction Options: the Reconstructionmentioning

confidence: 99%

Flap Decisions and Options in Soft Tissue Coverage of the Lower Limb

Jordan¹,

Malahias²,

Hindocha³

et al. 2014

TOORTHJ

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The lower extremities of the human body are more commonly known as the human legs, incorporating: the foot, the lower or anatomical leg, the thigh and the hip or gluteal region.The human lower limb plays a simpler role than that of the upper limb. Whereas the arm allows interaction of the surrounding environment, the legs’ primary goals are support and to allow upright ambulation. Essentially, this means that reconstruction of the leg is less complex than that required in restoring functionality of the upper limb. In terms of reconstruction, the primary goals are based on the preservation of life and limb, and the restoration of form and function. This paper aims to review current and past thoughts on reconstruction of the lower limb, discussing in particular the options in terms of soft tissue coverage.This paper does not aim to review the emergency management of open fractures, or the therapy alternatives to chronic wounds or malignancies of the lower limb, but purely assess the requirements that should be reviewed on reconstructing a defect of the lower limb.A summary of flap options are considered, with literature support, in regard to donor and recipient region, particularly as flap coverage is regarded as the cornerstone of soft tissue coverage of the lower limb.

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Free Vascularized Tissue Transfer for Limb Salvage in Peripheral Vascular Disease

Cited by 26 publications

References 24 publications

The possibility of free tissue transfer as a nutrient flap for critical ischemic foot: A case report

The possibility of free tissue transfer as a nutrient flap for critical ischemic foot: A case report

Evidence to Support Controversy in Microsurgery

Flap Decisions and Options in Soft Tissue Coverage of the Lower Limb

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