Microsurgical Management of Extremity Wounds in Diabetics with Peripheral Vascular Disease

Oishi, Scott N.; Levin, L. Scott; Pederson, William C.

doi:10.1097/00006534-199309000-00017

Cited by 76 publications

(51 citation statements)

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“…Despite such an aggressive approach to limb salvage, a high incidence of limb amputation still occurs due to an inability of these maneuvers alone to limit the progression of gangrene or tissue necrosis with resultant tendon or bone exposure [5]. This has been the impetus for attempting free tissue coverage of these more complex distal leg wounds [2][3][4]6]. A major obstacle due to this severe peripheral vascular disease has been a lack of satisfactory recipient vessels to serve as inflow conduits for the free tissue transfer.…”

Section: Discussionmentioning

confidence: 99%

Section: Abstract: Microsurgery -Free Flap -Steal Syndrome -Limb Ampmentioning

confidence: 99%

“…Success rates greater than 90% have been reported for such free tissue transfers [3,6]. Morbidity and mortality rates have been found to parallel that for vascular reconstruction alone in these patients who invariably have multiple other medical problems [6]. Complications inherent with any free tissue transfer have been well described, with the most devastating being anastomotic thrombosis or disruption, which usually resulted in total flap failure [7].…”

Section: Abstract: Microsurgery -Free Flap -Steal Syndrome -Limb Ampmentioning

confidence: 99%

“…Complications inherent with any free tissue transfer have been well described, with the most devastating being anastomotic thrombosis or disruption, which usually resulted in total flap failure [7]. However, ischemia of the recipient extremity itself due to a "steal syndrome" as a direct consequence of diversion of inflow by a successful free flap, although previously speculated as a theoretical but unlikely possibility [4][5][6], has not been specifically deCorrespondence to: G. G. Hallock, MD, 1230 South Cedar Crest Boulevard, Suite 306, Allentown, PA 18103, USA scribed as an outcome. Therefore, this case is unusual as it describes progressive critical lower extremity ischemia distal to a successful free flap that resulted in limb amputation.…”

Section: Abstract: Microsurgery -Free Flap -Steal Syndrome -Limb Ampmentioning

confidence: 99%

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Free flap ?steal? hastening amputation of a revascularized lower limb

1995

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European ]['~hl ,dO %na, of lff_lflS[lC bu¢ ery Abstract. Complex limb threatening wounds secondaryto end-stage atherosclerotic peripheral occlusive disease remain significant challenges that frequently mandate vascularized tissue coverage that can only be achieved with a microsurgical composite tissue transfer. Following or concurrent with limb revascularization, the theoretical risk that such a free flap could divert flow to a comparably lower resistance system of the flap has been previously considered hypothetical. We present a case report where we believe such a "steal syndrome" did occur as suggested by arteriogram, and this adverse phenomenon hastened limb amputation. This possible risk must be carefully explained and accepted by these patients prior to embarking on these complex limb salvage attempts.

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Section: Discussionmentioning

confidence: 99%

Section: Abstract: Microsurgery -Free Flap -Steal Syndrome -Limb Ampmentioning

confidence: 99%

Section: Abstract: Microsurgery -Free Flap -Steal Syndrome -Limb Ampmentioning

confidence: 99%

Section: Abstract: Microsurgery -Free Flap -Steal Syndrome -Limb Ampmentioning

confidence: 99%

See 2 more Smart Citations

Free flap ?steal? hastening amputation of a revascularized lower limb

1995

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“…10 In our experience, we have observed that in severe and wide lesions of the limbs, microsurgery procedures can be successfully combined, after debridement, with HBO, VAC, and selective antibiotic therapies, whose effect is to limit the extension of the area to be repaired, improve the trophism of the chronically inflamed tissue around the ulcer, and create the conditions most suitable for the implant of free flaps.…”

Section: à8mentioning

confidence: 99%

Delayed microsurgical reconstruction of the extremities for complex soft-tissue injuries

et al. 2005

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The treatment of severe wounds of the extremities, characterized by large posttraumatic tissue loss, represents a clinical problem difficult to resolve, especially when the lesion is surrounded by large areas of ischemic distrophic tissue which progressively aggravate and extend the initial lesion, with frequent exposure of bone and joint structures making the amputation of the limb an inevitable outcome. The authors present their experience based on combined treatments by medical support methods such as hyperbaric oxygen (HBO) and vacuum-assisted closure therapy (VAC) and microsurgical reconstruction of the limbs, within a precise therapeutic protocol. The use of this protocol in appropriate times and ways allowed us to successfully treat severe posttraumatic sequelae of the limbs, avoiding the delayed healing typical of these pathologies, both on the donor site of the flap and on the repaired area, and avoiding unsuitable microsurgical reconstruction of limbs, allowing satisfactory morpho-functional restoration and a reduction of the hospitalization period.

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Extended Techniques for Limb Salvage Using Free Flaps

Feldman¹,

Levin²

2004

Haimovici's Vascular Surgery

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Microsurgical Management of Extremity Wounds in Diabetics with Peripheral Vascular Disease

Cited by 76 publications

References 0 publications

Free flap ?steal? hastening amputation of a revascularized lower limb

Free flap ?steal? hastening amputation of a revascularized lower limb

Delayed microsurgical reconstruction of the extremities for complex soft-tissue injuries

Extended Techniques for Limb Salvage Using Free Flaps

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