Free-tissue transfer for lower-extremity reconstruction in the immunosuppressed diabetic transplant recipient

The technique of free-tissue transfer for complex wounds has become a common tool in reconstructive surgery. The use of this modality in immunosuppressed transplant patients, who often have associated metabolic and vascular disease, has not been well-documented. The authors report three cases of lower-extremity reconstruction in renal-transplant recipients, utilizing microvascular free-tissue transfer. All three patients were hypertensive diabetic patients with symptomatic peripheral vascular disease and chronic wounds. One patient presented with an exposed Achilles tendon; the second had a complex wound of the forefoot; and the third patient had a large ulceration on the heel of the right foot. These three patients underwent successful free-tissue transfer, and have regained full use of their limbs and ambulation. Free-tissue transfer in the immunosuppressed transplant recipient is a viable reconstructive option. Careful perioperative metabolic monitoring and surgical care are critical for success. A multispecialty approach is advocated, to coordinate limb salvage in these patients.