Key points are not available for this paper at this time.
PURPOSE: Multidisciplinary care with vascular and plastic surgery is critical to ensure success of lower extremity free flaps (LEFF) in the chronic wound population. There is a paucity of data regarding endovascular revascularization (ER) combined with LEFF including performing direct ER on the flap recipient artery. We compared the outcomes of patients with targeted revascularization (TR) to the recipient artery versus non-targeted revascularization (NR) to other arteries prior to LEFF. METHODS: A retrospective review of 55 patients who underwent ER prior to their LEFF was reviewed. Demographics, comorbidities, angiographic and intraoperative details, and outcomes were collected. RESULTS: A total of 55 LEFF patients were analyzed: 49.1% (n=28) underwent TR and 50.9% (n=27) underwent NR. Median Charlson Comorbidity Index was 5. Microsurgical flap success was 98.2%. Post-operatively, 45% (n=25) of all patients underwent additional angiogram (TR= 15, NR =10). In the TR group, 73% (n=11) required re-intervention and 100% (n=10) of the NR group required re-intervention. No significant differences were found in rates of any postoperative flap complications, takeback, partial flap necrosis, dehiscence, or infection. There were no significant differences in rates of postoperative amputation or mortality between the two cohorts. CONCLUSION: Close follow-up with vascular surgery and plastic surgery is required for patients who undergo endovascular revascularization prior to LEFF, with nearly half of patients requiring additional endovascular procedures for overall limb salvage. There were no significant differences in complication rates for the TR and NR groups for LEFF, demonstrating that TR does not appear to affect microsurgical anastomosis.
Li et al. (Wed,) studied this question.