Abstract
Purpose
Complex injuries of the extremity can be very challenging to treat. In the setting
of soft tissue infection and vascular defect, arterial reconstructions are at high
risk of failure. Historically, there have not been good options to successfully salvage
limbs with these serious injuries. We describe our experience of utilizing a cross
limb vessel transfer to salvage the limb.
Methods
Patients were identified retrospectively with complex vascular injuries of the extremity
and wound infection, who were treated with a cross limb vessel transfer. Once the
infection has successfully been cleared, flow-through flap transfer was performed
for definitive reconstruction of the arterial injury. Data collated included patient
demographics, injury and operation details, and post-operative outcomes including
blood supply of the limb, wound infection and complications.
Results
Between April 2014 and January 2017, 3 patients with an average age of 21 years (range,
16–29) were admitted. The median length of hospital stay was 62 days (range, 26–122).
The average number of operation was 7.3 times (range, 6–10). Two patients’ upper limb
had survived with limited movement, relatively minor donor site morbidity and confirmed
flow through the vessel reconstruction using CTA, while one patient had lower limb
amputation due to severe infection and prolonged ischemia time.
Conclusions
This series of patients demonstrates that cross limb vessel transfer is an invaluable
technique to salvage the limb in patients with complex vascular injury and wound infection.
However, for lower limb with prolonged ischemia time and severe infection, limb salvage
is not recommended.
Keywords
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Article info
Publication history
Published online: November 08, 2019
Footnotes
☆This paper is part of a Supplement supported by the European Federation of Societies of Microsurgery (EFSM) and the Serbian Society for Reconstructive Microsurgery (SSRM).
Identification
Copyright
© 2019 Published by Elsevier Ltd.
