Free-Tissue Transfers for Limb Salvage Utilizing in Situ Saphenous Vein Bypass Conduit as the Inflow.
Using vein grafts to bypass sclerotic and occluded arterial segments is a well-established technique in vascular surgery. For infrapopliteal bypass, autogenous veins have better patency rates than synthetic grafts. Although not resolved, in situ bypasses seem to be better than reversed bypasses, especially for "far away" segments. Although the etiology is not understood, it is a well-known clinical finding that sclerosis affects arteries more than the veins and, as a whole, is more advanced in lower extremities compared with the trunk and upper extremities. Our experience with eight patients in whom critical soft-tissue defects were covered with free-tissue transfers in severely compromised lower extremities utilizing the in situ saphenous vein bypass as the inflow is presented. Simultaneous bypass and free-tissue transfers were performed in seven and delayed free-tissue transfer was done in one. Follow-up ranged from 6 months to 3 years. To date, two patients underwent amputations. Five patients are able to maintain bipedal ambulation. One patient is wheelchair-bound with intact lower extremities. In well-selected patients, this procedure may offer an alternative treatment to amputation. However, because of the complexity of these combined procedures, we strongly urge careful patient selection.
Published In/Presented At
Chowdary, R. P., Celani, V. J., Goodreau, J. J., McCullough, J. L., McDonald, K. M., & Nicholas, G. G. (1991). Free-tissue transfers for limb salvage utilizing in situ saphenous vein bypass conduit as the inflow. Plastic And Reconstructive Surgery, 87(3), 529-535.
Medicine and Health Sciences | Other Medical Specialties | Surgery
Department of Medicine, Department of Medicine Faculty, Department of Surgery, Department of Surgery Faculty, Department of Surgery Residents