Combined vascular reconstruction and microvascular muscle flap transfer for salvage of ischaemic legs with major tissue loss and wound complications

Objective: To assess the safety and short-term efficacy of combined vascular revascularisation and free microvascular muscle flap transfer in patients with advanced lower limb ischaemia caused by occlusive arterial disease. Design: A prospective follow-up study of 2-72 months. Setting: Academic referral centre. Materials: Consecutive first 25 patients with extensive tissue loss due to advanced leg ischaemia or wound complications after bypass surgery. Chief outcome measures: Graft patency, free tissue transfer viability, amputation rate. Main results: There was no perioperative mortality The cumulative rates for secondary vascular patency, microvascular graft viability and limb salvage were 80%, 87% and 76% at one year provided that vessels and grafts that were functioning at the time of amputation were considered lost to follow-up rather than failed at that point. If, however, amputation was also regarded as vessel and graft failure the corresponding rates were 68%, 62% and 76%, respectively Conclusions: Combining microvascular muscle flap transfer with vascular reconstruction for salvage of legs with extended ischaemic tissue loss or wound complications after bypass surgery gave acceptable preliminary results and deserves an attempt in selected patients.