Successful lower extremity salvage with free flap after endovascular angioplasty in peripheral arterial occlusive disease.

Abstract

OBJECTIVE: Most patients with peripheral arterial occlusive disease undergo lower

limb amputation due to complex wounds on their lower extremities. We have taken

the challenging approach of combining angioplasty and free tissue transfer for

limb salvage. METHODS: Between October 2011 and December 2013, 11 patients

(average age of 56.8 years; ranged from 43-72 years old) with peripheral arterial

occlusive disease of main tibioperoneal arteries underwent preoperative

angioplasty. Afterward, free tissue transfers (nine anterolateral thigh free

flaps, one vastus lateralis muscle free flap, and one deep femoral artery

perforator flap) were performed on these patients for lower extremity salvage and

reconstruction. RESULTS: All 11 free tissue transfers after angioplasty were

successful without operative mortality or major complications. Minimal wound

dehiscence was seen in one case, and partial flap necrosis was seen in the other

cases. During the follow-up period, all of the patients had their wounds healed

completely and achieved acceptable contour and quality of gait. CONCLUSION: The

preoperative angioplasty provides well-vascularized tissue that both controls

infection and helps free flaps to survive. Therefore, the patients due to receive

leg amputation in spite of the free tissue transfer can achieve limb salvage by

using the additional technique of angioplasty. This combined approach was

successful in preserving the functional aspects along with the aesthetic results

for the lower limb reconstruction.