Combined Arterial Reconstruction and Free Tissue Transfer for Patients with Critical Limb Ischemia

OBJECTIVE: The purpose of treatment for critical limb ischemia (CLI) is to prevent major amputation. The purpose of this study was to evaluate our experience of treating CLI with free tissue transfer (FTT) and revascularization. MATERIALS AND METHODS: From January 2010 to December 2012, seven lower extremities in seven patients were treated with revascularization and free tissue transfer for CLI with tissue loss. All seven patients had tissue loss with a Rutherford category 6 status. Six patients underwent bypass surgery, and one patient underwent percutaneous transluminal angioplasty for revascularization. All patients also underwent free tissue transfer using the latissimus dorsi muscle simultaneously and separately in two and five patients, respectively. RESULTS: Five of the seven patients exhibited flap patency and survival. One patient obtained flap survival and limb salvage, although the flap graft was occluded after the patient achieved limb salvage. One patient developed partial flap necrosis requiring skin grafting and acquired limb salvage. The flap survival rate was 85%, and the limb salvage rate was 100%. CONCLUSION: FTT with arterial reconstruction for CLI achieves successful wound healing and limb salvage. Both bypass surgery and endovascular treatment are useful for maintaining the vascular supply.