Abstract
Purpose: The increasing incidence of diabetes and dialysis patients is leading to a rise in the number of patients with critical limb ischemia. Despite recent increasing indications for distal bypass, endovascular revascularization and therapeutic neovascularization, a considerable number of patients must undergo major amputation when wounds of the foot or lower leg do not heal. In these patients, combined aggressive revascularization with a free flap transfer is applied in our hospital to cover on the defect, yielding limb salvage with good functional results. The purpose of this study was to evaluate the results of combined simultaneous arterial revascularization and free flap transfer in patients with critical limb ischemia. Patients and Methods: Between February 2004 and April 2010, 7 patients with arteriosclerosis obliterans (ASO) underwent a combination of arterial revascularization by means of saphenous vein grafting and free flap transfer. The mean age of patients was 67 years (range, 44–77 years). Of the 7 patients, 6 had diabetes mellitus and 4 patients had hemodialysis-dependent renal failure. The latissimus dorsi muscle was used as the donor muscle in all patients except 2 cases in the early stage. Results: Limb salvage failed in 1 patient due to ischemia of the free flap, requiring below-the-knee amputation. Limb salvage was successful in the remaining 6 patients. Of these, 4 achieved independent ambulation and 1 could walk with a short leg brace. Conclusion: Combined arterial revascularization and free flap transfer can save not only almost the full length of the limb, but also retain walking ability in many cases of critical limb ischemia. This combined technique provides immediate soft tissue coverage, allowing the possibility of early rehabilitation.
