Free tissue transfers for limb salvage in patients with end-stage renal disease on dialysis

Microvascular surgery plays a major role in the reconstructive process of limb salvage. However, microsurgery in the patient with renal disease is still considered a high-risk procedure. Some authors have even recommended immediate amputation because of poor long-term survival in patients with renal failure and lower limb ischemia.

A retrospective review of all patients with end-stage renal disease on hemodialysis who underwent free flap surgery at Dalin Tzu Chi General Hospital was included in the study. Data were collected over a 5-year period, between June of 2005 and June of 2009.

A total of 20 patients were included in the study, of which 11 were men and nine were women. The average age of the patients was 63 years. All had a history of diabetes mellitus with peripheral vascular disease. Seven of the 20 patients had undergone prior vascular intervention. The total flap survival rate was 95 percent. Four patients eventually required major limb amputation because of progressive infection at the recipient site. There were no further major limb amputations in these patients during the long-term follow-up. The total limb salvage rate was 80 percent. The average follow-up was 30 months.

The authors' present approach shows that the results of limb salvage in this particular group of patients are not as discouraging as previously reported. In the description of patients with renal disease, the authors suggest that they not be described as one entity but that they be divided into subgroups so that this better reflects the risk of surgery and the success of limb salvage.