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

Objectives: To evaluate the results and complications of combined simultaneous arterial re-vascularisation and free flap transfer in patients with critical Limb ischaemia and large soft-tissue defects that would otherwise have required major amputation. Design: Retrospective analysis of all combined procedures performed between 1993 and 2007 with regard to complications and outcome. Materials and methods: Seventy-eight procedures were performed in 76 patients with a mean age of 60 years (range: 18-80 years). The majority had diabetes (70.5%). Follow-up was obtained from hospital charts and telephone contacts with patients or GPs. Results: The limb-salvage rate was 93% after 1 year, 80% after 3 years and 71% after 5 years. Perioperative complications occurred in 50% of the patients; six out of 78 (7.7%) arterial reconstructions and 13 out of 78 (16.7%) flaps had to be revised during the early postoperative period. However, most flaps could be saved by a secondary procedure resulting in an early failure (amputation) rate of 6%. In-hospital mortality was 3.8%. End-stage renal disease was the only factor predicting Limb toss. In total, 65% of the patients survived and were able to walk on their reconstructed limb at 1-year follow-up. Combined survival and limb-salvage rates were 85%, 66% and 51% after 1, 3 and 5 years. Conclusions: Combined arterial re-vascularisation and free flap transfer can be performed safety with acceptable morbidity and mortality and should be considered for every mobile patient with large soft-tissue deficit (> 10 cm(2)) without end-stage renal disease prior to major amputation. (C) 2009 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.