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Updated: May 18, 2026
A Pre-clinical Rat Model for the Study of Ischemia-reperfusion Injury in Reconstructive Microsurgery
Published on: November 8, 2019
Free flap reconstruction after recent lower limb revascularization: a matched cohort analysis of safety and limb
Cédric Zubler1, Giulio Jad Jaber2, Marcus Wölffer3
1Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust, London, United Kingdom; Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, Freiburgstrasse 18, Bern 3010, Switzerland.
Background:
Free flap reconstructions of the lower extremity in patients requiring prior vascular intervention remains challenging. Restoration of adequate blood flow is essential for flap survival and limb salvage, yet compromised recipient vessels may increase perioperative risk. This study compares outcomes of microvascular lower limb salvage following recent vascular intervention with matched controls without prior revascularization.
Patients And Methods:
A retrospective two-centre matched cohort study was conducted including all lower limb free flap reconstructions performed between 2006 and 2024. Patients who underwent significant vascular interventions in the same limb within 100 days prior to reconstruction were identified and matched 1:1 with controls.
Results:
Of the screened 821 reconstructions, 34 patients (4.1%) had undergone recent vascular intervention, predominantly percutaneous transluminal angioplasty (82.4%). Operative time was significantly longer in vasculopathic patients (456 vs. 364 min; p=0.003). Flap success was 88.2% in the intervention group versus 100% in controls (p=0.13). All flap losses (n=4) occurred when microvascular anastomoses were performed on the same vessel that previously underwent vascular intervention, corresponding to a 28.6% failure rate in this subgroup (p<0.03). Overall secondary amputation rates were identical in both groups (5.9%). Limb salvage was ultimately achieved in 94.1% of vasculopathic patients.
Conclusions:
When managed within a specialised multidisciplinary setting, free flap reconstruction after recent vascular intervention is feasible and enables limb salvage in the vast majority of cases, despite increased operative complexity and a trend towards higher flap-related complications. Accordingly, these patients should not be denied gold standard treatment solely based on concerns about microvascular challenges.
