Combined femoro-distal endovascular revascularisation and plastic reconstruction with free-flap transfer in large ischemic ulcers of lower limbs

Background. Diabetic patients with lower limb critical ischemia and large trophic lesions in most cases require above or below knee amputation. Combined vascular infrainguinal revascularisation and microvascular free flap transfer allow, in selected cases, the preservation of limb function. Methods. In this study we report our experience of 3 diabetic patients with large trophic lesions of the lower limbs treated, in the past year, with endovascular femorotibial revascularisation combined with free-tissue transfer. The revascularisation procedures consisted of tibial PTA in 2 cases and superficial femoral PTA in 1 case. The plastic reconstruction was made using free-flap muscle tissue with skin graft. Results. Functional limb salvage was achieved in 2 patients, whereas 1 patient underwent an above-knee amputation following local infective complications at 10 months. Conclusions. These results are encouraging and in selected cases this combined procedure may offer an alternative treatment to amputation. However, the complexity of this technique not only involves the surgical operation itself, but also the postoperative care. Close collaboration between the vascular surgeon, plastic surgeon and physician is important to plan the surgical strategy and patient care.