Background: Patients with complex lower extremity (LE) wounds and single-vessel LE runoff (1-VRO) are often considered for amputation. While more challenging, free tissue transfer (FTT) is a means for limb salvage. This study aims to demonstrate the feasibility of limb salvage with FTT in patients with 1-VRO.
Methods: Patients undergoing FTT by a single surgeon between 2011 and 2021 were retrospectively reviewed. Data collected included demographics, wound characteristics, vascular status, and operative details. Patients were divided into cohorts based on 1- versus 3-VRO of tibial vessel inflow. Outcomes of interest included postoperative complications such as flap necrosis, flap success, limb salvage, and ambulatory status.
Results: A total of 188 patients underwent FTT to LE, with 25 patients (13.3%) having 1-VRO. Patients with 1-VRO had a comparable prevalence of diabetes (56.0% vs. 50.0%, = 0.569) and end-stage renal disease (8.0% vs. 3.7%, = 0.319). Osteomyelitis was more common in the 1-VRO group (80.0% vs. 60.1%, = 0.056). FTT donor sites and flap composition were similar between cohorts. At mean follow-up of 21.2 months (interquartile range 24.5:5.6, 30.1 months), limb salvage rates were similar between cohorts (84.0% vs. 91.4%, = 0.241), with no significant differences in ambulatory status or mortality. Higher complication rates occurred in the 1-VRO cohort (48.0% vs. 21.5%, = 0.004), of which partial flap necrosis was more prevalent in the 1-VRO group (8.0% vs. 1.2%, = 0.029). There was no difference in flap success rates between groups ( = 0.805). More postflap angiograms were performed in the 1-VRO group (32.0% vs. 9.2%, = 0.001), but there was no difference in need for repeat percutaneous endovascular intervention between groups.
Conclusion: This study demonstrates that FTT reconstruction to the LE remains a reliable reconstruction option for limb salvage in patients with single-vessel supply to the LE. Reliance on advanced perioperative management and patient optimization is effective at reducing negative outcomes.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1055/a-2181-7149 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Limb salvage prediction in peripheral artery disease patients using angiographic computer vision.
Vascular
January 2025
Department of Vascular Surgery, University Hospital Leipzig, Leipzig, Germany.
Background: Peripheral artery disease (PAD) outcomes often rely on the expertise of individual vascular units, introducing potential subjectivity into disease staging. This retrospective, multicenter cohort study aimed to demonstrate the ability of artificial intelligence (AI) to provide disease staging based on inter-institutional expertise by predicting limb outcomes in post-interventional pedal angiograms of PAD patients, specifically in comparison to the inframalleolar modifier in the Global Limb Anatomic Staging System (IM GLASS).
Methods: We used computer vision (CV) based on the MobileNetV2 model, implemented via TensorFlow.
Article Synopsis
- Limb salvage surgery is now the main treatment for patients with malignant tumors in the limbs and pelvis.
- Endoprostheses are the primary option for reconstructing the limb after tumor removal, known for being modular, cost-effective, and durable.
- Managing infections in endoprostheses requires a tailored approach based on various factors, highlighting the need for a clear framework for assessment and treatment.
Endoscopic Vein Harvest Is Associated with Worse but Improving Outcomes in Infrainguinal Bypass.
J Vasc Surg
December 2024
Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, USA. Electronic address:
Objective: The impact of great saphenous vein harvest technique on infrainguinal bypass outcomes remains a matter of debate, with no robust evidence favoring a specific technique over the other. This study aims to compare the outcomes of open vein harvest with endoscopic vein harvest in patients undergoing infrainguinal bypass surgery.
Methods: Patients who underwent an infrainguinal bypass from a femoral origin using a single-segment great saphenous vein between 2011 and 2023 were identified in the Vascular Quality Initiative infrainguinal bypass module.
Comparison of Patient-Reported Outcomes after Local Flap Coverage versus Amputation for Complex Lower Extremity Trauma.
Indian J Plast Surg
December 2024
Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States.
There is a paucity of patient-reported outcomes (PROs) data in lower extremity salvage. Limb salvage can often be achieved with the use of local muscle flaps or fasciocutaneous flaps. The purpose of this study was to compare PROs of patients who underwent lower extremity salvage using local fasciocutaneous flaps or muscle flaps to lower extremity amputation.
View Article and Find Full Text PDFOutcomes of Scapular Osteosarcoma.
Anticancer Res
January 2025
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A.;
Background/aim: Scapular osteosarcoma is a rare malignancy, and the understanding of its optimal treatment strategies and long-term outcomes remains limited. The purpose of the current study was to evaluate our institutional experience.
Patients And Methods: We reviewed 14 patients (8 females, 5 males; mean age 44±17 years) treated for scapular osteosarcoma from 1985 to 2022.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!