Introduction: Microsurgery is indicated for the treatment of critical limb ischemia (CLI) for: (1) surgical revascularization (microsurgical distal bypass) or (2) endovascular treatment + free tissue transfer, or (3) free tissue transfer anastomosing into the bypass graft.
Results: In Group 1, there were 17 cases (20 limbs) . Patient undergoing hemodialysis was 75% (15 limbs) . The bypass patency rate was 52.3%, and the amputation-free survival rate was 67.2% at one year postoperatively. There were eight cases in Group 2. Patients undergoing hemodialysis was 62.5%. Free tissue survival rate was 88% with partial necrosis in 37.5%, and one case with total necrosis. Amputation-free survival rate was 60% at an average follow-up of 31.4 months. In Group 3, there were two male patients, and one of them was on hemodialysis. The free tissue survival rate was 100%; however, partial necrosis was observed in one patient. The amputation free survival rate was 0% at average follow-up of 12 months.
Conclusion: Microsurgery technique was useful in CLI treatment. However, composite free tissue transfer may be more prone to partial flap necrosis. The high rate of CLI patients undergoing hemodialysis may make the results worse.
