[New trends in limb salvage. Vascularized flaps]

Area of Science:

• Vascular Surgery
• Reconstructive Surgery
• Limb Salvage Procedures

Context:

• Critical chronic ischemia poses challenges when femoro-distal bypass is not feasible or indicated.
• Patients with extensive gangrene and high risk of sepsis require alternative limb salvage strategies.
• Inframalleolar reconstruction is often difficult due to limited bypass options.

Purpose:

• To analyze the outcomes of nutrient flaps in patients with critical limb ischemia.
• To evaluate the efficacy of nutrient flaps in limb salvage when conventional revascularization fails.
• To determine the limb salvage and patency rates of nutrient flaps in complex cases.

Summary:

• Nutrient flaps, including latissimus dorsi and radial artery free flaps, were used in 12 patients with extensive gangrene compromising limb salvage.
• Hospital mortality was 8.3%, with cumulative limb salvage rates of 67% at 6 and 12 months.
• Patency rates were 58% at 6 months and 44% at 12 months, indicating moderate success in maintaining vascular supply.

Impact:

• Nutrient flaps provide a crucial alternative for limb salvage in critical ischemia when bypass surgery is contraindicated or unsuccessful.
• These procedures can effectively cover tissue loss, manage infection, and restore vascular supply to the foot.
• The study demonstrates that nutrient flaps can achieve a fair limb salvage rate, offering hope for patients with complex vascular conditions.