Vascular Compromised Lower Leg Reconstruction with Modified Microsurgical Salvage Procedures

ABSTRACT

In the past 5 years, the authors have performed microsurgical reconstruction of the lower leg in 37 patients. Among them, modified microsurgical salvage procedures were performed in 11(29.7) cases with vascular compromise, suggested by the preoperative angiogram of the affected lower leg demonstrating no visible, or only one visible major arter. Modified salvage procedures included free flap operations using distally-based arterial inflow(n=2), temporary diversion of the single main artery with secondary vein grafting(n=2), Jungcross-leg fashioned free flaps(n=4), and end-to-side anastomosis of the main artery((n=1). In absence of arterial flow after lower leg trauma, as interpositional vein graft(n=2) was performed to restore blood flow. No vascular problems occurred after the free flap transfer. However, 9 patients experienced different degrees of limping gait, ranging from as mild(n=2), moderate(n=6) to severe(n=1) at the mean follow-up period of 18 months. In reconstruction of a vascular compromised lower leg, modified salvage procedures should be reviewed and selected after exploration of all vessels, both proximal and distal to the zone of the injury. When evaluating what method is the most appropriate, socioeconomic efficiency and patients' individual requirments should be considered.