Outcomes of microvascular reconstruction of single-vessel lower extremities: limb salvage versus amputation

Many patients with complex wounds on single-vessel lower extremities undergo amputation. Limb salvage using microvascular reconstructive techniques is an alternative in these patients that can preserve ambulatory status, but data focused on reconstruction in the single vessel population have been limited. A retrospective review of all microvascular lower-extremity reconstructions from August 2003 to December 2008 was performed. Forty-two patients were identified, of which 10 were found to have a complex wound and single-vessel perfusion to the affected extremity. Patient charts were reviewed for age, sex, medical comorbidities, mechanism of injury (traumatic versus nontraumatic), wound location, flap type, complications, flap outcome, and limb salvage outcome. All 10 flaps were successful (100%), and long-term limb salvage was 90%. Mean follow-up was 20.4 months. There were two complications, a hematoma and a case of flap success followed by reactivation of osteomyelitis 3 months after the free flap procedure resulting in below-knee amputation. The ultimate goal of limb salvage is to maximize limb length in an effort to prevent an increase in the energy of ambulation. Using microvascular reconstructive techniques, it can be performed successfully and with the majority of patients regaining an ambulatory status.