A Multidisciplinary Approach to End-Stage Limb Salvage in the Highly Comorbid Atraumatic Population: An Observational...

Area of Science:

• Reconstructive surgery
• Limb salvage surgery
• Microsurgery

Background:

• Chronic lower extremity (LE) wounds pose significant challenges to limb salvage.
• Free tissue transfer (FTT) is an established reconstructive option for complex LE wounds.
• Management requires addressing comorbidities, infection, vascularity, and biomechanics.

Purpose of the Study:

• To evaluate the efficacy and outcomes of FTT for chronic LE limb salvage.
• To analyze patient characteristics, surgical details, and long-term results.
• To identify critical factors for successful limb salvage in a comorbid population.

Main Methods:

• Retrospective review of 300 atraumatic LE FTTs performed by a single surgeon (July 2011-January 2023).
• Data collected included patient demographics, comorbidities, preoperative workup, operative details, flap outcomes, and complications.
• Analysis focused on factors influencing limb salvage success.

Main Results:

• The study included 300 patients (average age 55.9 years; 70.7% male).
• Common comorbidities: diabetes (54.7%), peripheral vascular disease (PVD: 35%), chronic kidney disease (CKD: 15.7%).
• Overall FTT success rate was 96.3%, with a 12.7% postoperative ipsilateral amputation rate.

Conclusions:

• Successful limb salvage is achievable with FTT in patients with significant comorbidities like diabetes, PVD, and end-stage renal disease.
• Comprehensive preoperative assessment, including extensive testing and diabetes management, is crucial.
• Postoperative monitoring and long-term multidisciplinary care are vital for sustained limb salvage success.