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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

A Journal on Vascular and Endovascular Surgery


Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 2003 June;10(2):111-20

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English, Italian

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

Russo D. 1, Calcagni M. 2, Faglia E. 3, Pajardi G. 2, Gabrielli L. 1

1 UF Chirurgia Vascolare Policlinico Multimedica, Sesto San Giovanni (Milano) 2 UF Chirurgia Plastica Policlinico Multimedica, Sesto San Giovanni (Milano) 3 UF Medicina Policlinico Multimedica, Sesto San Giovanni (Milano)


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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.

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