PDF icon Download PDF
J Reconstr Microsurg 2024; 40(05): 384-391
DOI: 10.1055/a-2181-7149
Original Article

Implications of Single-Vessel Runoff on Long-Term Outcomes of Free Tissue Transfer for Lower Extremity Reconstruction

Samuel S. Huffman 
1   Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
2   Georgetown University School of Medicine, Washington, District of Columbia
,
John D. Bovill
2   Georgetown University School of Medicine, Washington, District of Columbia
,
Karen Li 
1   Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
,
Daisy L. Spoer 
1   Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
2   Georgetown University School of Medicine, Washington, District of Columbia
,
Lauren E. Berger 
1   Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
3   Plastic and Reconstructive Surgery Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
,
Jenna C. Bekeny 
1   Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
,
Cameron M. Akbari
4   Department of Vascular Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
,
Kenneth L. Fan
1   Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
,
Karen K. Evans
1   Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
› Author Affiliations
› Further Information
Also available atMedOne
   Permissions and Reprints
Preview

Abstract

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%, p = 0.569) and end-stage renal disease (8.0% vs. 3.7%, p = 0.319). Osteomyelitis was more common in the 1-VRO group (80.0% vs. 60.1%, p = 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%, p = 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%, p = 0.004), of which partial flap necrosis was more prevalent in the 1-VRO group (8.0% vs. 1.2%, p = 0.029). There was no difference in flap success rates between groups (p = 0.805). More postflap angiograms were performed in the 1-VRO group (32.0% vs. 9.2%, p = 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.

Keywords

limb salvage - amputation - free tissue transfer - end-to-side anastomosis - vessel runoff

Financial Disclosure Statement

There are no financial disclosures, commercial associations, or any other conditions posing a conflict of interest to report for any of the above authors.


Authors' Contributions

S.S.H., J.D.B., K.L., and J.C.B. conceived of the presented idea. S.S.H. developed the theory and performed the computations. S.S.H. and J.D.B. verified the analytical methods. All authors discussed the results and contributed to the final manuscript.




Publication History

Received: 11 June 2023

Accepted: 18 September 2023

Accepted Manuscript online:
26 September 2023

Article published online:
14 December 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA