Inferior Limb Salvage by Combined Free-tissue Transfer and the Crane Principle Revisited

Abstract

Summary:Aggressive treatment of ischemia of the lower extremities has decreased the number of amputations in both diabetic and nondiabetic patients; combined vascular reconstruction and microvascular free-flap transfer has been used to improve distal perfusion and cover large tissue defects caused by the critical limb ischemia during the past 30 years. We present our experience with a 71-year-old diabetic patient who underwent revascularization with a vascular bypass and a simultaneous microvascular flap reconstruction for limb salvage after domestic trauma. An extension of the “crane” principle was used to solve bypass exposure due to wound late complication. After 1-year follow-up, the patient was able to walk without pain. Combining 3 well-established methods of arterial revascularization and free-flap transfer and the old “crane principle,” we achieved limb salvage, offering an alternative to below-knee amputation.

Reconstruction of a secondary scalp defect using the crane principle and a split-thickness skin graft

“…Most plastic surgeons nowadays are not familiar with this principle. Nevertheless, the concept is still useful in selected cases, especially in the management of the complication of the previous flap [ 17 ].…”