Advanced Leg Salvage

Untreated chronic critical leg ischemia usually leads to major amputation or the patient's death. Amputation decreases the quality of life of this elderly patient population. Lower limb revascularization is clinically worthwhile and can decrease the amputation rate by up to 60%. Increased perfusion in the ischemic tissue is the prerequisite for success. In some of these cases, only long bypass grafts can diminish the need for major amputa tion. However, even infrapopliteal reconstruction may be insufficient treat ment in case of major ischemic tissue loss. Large, infected tissue defects with exposed tendons and bones may not heal, despite successful bypass grafting and local wound care that includes several aggressive debridements and skin grafting attempts. In most cases, local flaps cannot be used for wound cover age. Therefore, a number of patients with ischemic tissue loss are still at risk for major amputation despite successful revascularization. The use of free tis sue transfer in the management of major tissue loss secondary to athero thrombotic disease with or without diabetes mellitus, was introduced in the late 1980s. During the last decade, this method was used more frequently in institutions devoted to leg salvage. Several series reported impressive results, and three studies had life-table analysis as well. Our results showed that early coverage with free muscle flaps may achieve leg salvage, even in patients with infected autogenous vein grafts.