Limb Salvage Rates and Functional Outcomes Using a Longitudinal Slit Arteriotomy End-to-Side Anastomosis for Limb-Threatening Defects in a High-Risk Patient Population.

Abstract

BACKGROUND:

Limb salvage techniques using free tissue transfer in patients with chronic wounds caused by longstanding osteomyelitis, diabetes, and peripheral vascular disease are technically challenging. The longitudinal slit arteriotomy end-to-side anastomosis is the authors' preferred technique because it is the least invasive arteriotomy and is especially important for diseased recipient arteries. The authors reviewed highly comorbid patients who underwent free tissue transfer with this technique to understand the success rates, overall outcomes, and long-term limb salvage rates.

METHODS:

A retrospective review was performed to analyze outcomes of free tissue transfer using longitudinal slit arteriotomy end-to-side anastomosis between 2012 and 2018 performed by the senior surgeon (K.K.E.).

RESULTS:

One hundred fifteen free flaps were identified. Patients were, on average, 55.9 years old, with a body mass index of 29.2 kg/m. Comorbidities included osteomyelitis (83.5 percent), hypertension (60.9 percent), tobacco use (46.1 percent), diabetes (44.3 percent), peripheral vascular disease (44.3 percent), hypercoagulability (35.7 percent), and arterial calcifications (17.4 percent). Overall flap success was 93.0 percent; 27.8 percent required reoperation perioperatively because of complications. On univariate analysis, diabetes mellitus, hypertension, and hypercoagulability were significantly associated with eventual amputation (p < 0.05). Multivariate analysis showed that intraoperative thrombosis and take back was independently associated with flap failure. There was an overall limb salvage rate of 83.5 percent, and of those salvaged, 92.7 percent were ambulating without a prosthesis at a mean follow-up of 1.53 years.

CONCLUSIONS:

This is the largest series of longitudinal slit arteriotomy end-to-side anastomosis for patients undergoing free tissue transfer for limb-threatening defects in the compromised host. Overall flap success, limb salvage rates, and functional outcomes are high using this technique.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.

• Authors: Cara Black, Kenneth L Fan, Michael V Defazio, Kyle Luvisa, Kyle Reynolds, Vikas S Kotha, Christopher E Attinger, Karen K Evans
• Journal: Plastic and reconstructive surgery (Plast Reconstr Surg) Vol. 145 Issue 5 Pg. 1302-1312 (05 2020) ISSN: 1529-4242 [Electronic] United States
• PMID: 32332556 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Anastomosis, Surgical (adverse effects, methods, statistics & numerical data)
• Arteries (surgery)
• Chronic Disease (therapy)
• Critical Illness (therapy)
• Diabetic Foot (complications, epidemiology)
• Female
• Free Tissue Flaps (adverse effects, transplantation)
• Humans
• Ischemia (diagnosis, etiology, surgery)
• Leg (blood supply, surgery)
• Limb Salvage (adverse effects, methods, statistics & numerical data)
• Male
• Middle Aged
• Osteomyelitis (complications, epidemiology)
• Peripheral Vascular Diseases (complications, epidemiology)
• Postoperative Complications (epidemiology, etiology)
• Retrospective Studies
• Risk Factors
• Severity of Illness Index
• Smoking (adverse effects, epidemiology)
• Treatment Outcome
• Young Adult