The Utility of Preoperative Arteriography for Free Flap Planning in Patients with Chronic Lower Extremity Wounds.
The Utility of Preoperative Arteriography for Free Flap Planning in Patients with Chronic Lower Extremity Wounds.
- 2019
BACKGROUND: In patients with lower extremity wounds, free tissue transfer is often the last option before amputation, making it crucial to optimize preoperative planning in order to prevent flap breakdown. No consensus exists regarding preoperative vascular work ups before lower extremity free tissue transfer. Here we analyzed the utility of using arteriography for lower extremity free flap planning. CONCLUSIONS: Preoperative lower extremity arteriography aids in the diagnosis of peripheral vascular disease, allows for timely endovascular intervention, and allows for optimal flap recipient vessel selection with a low complication rate. METHODS: A retrospective review was performed of 57 patients who underwent lower extremity arteriography and 59 free flap operations for lower extremity wounds between November 2014 and August 2017. Findings were used to guide flap recipient vessel selection. Arterial pathology was addressed via endovascular intervention, where appropriate. Encountered pathology was described and patient demographics, comorbidities, and outcomes were analyzed for correlation with abnormal angiographic studies. RESULTS: Angiographic abnormalities were observed in 40 patients (67.8%), including 23 (57.5%) with stenosis/occlusion, 20 (50.0%) with atretic/non-visualized vessels, and 11 (27.5%) requiring endovascular intervention. Stenosis/occlusion was detected in 9 patients (15.3%) with no previously known arterial disease, leading to a new diagnosis of peripheral vascular disease. Flap survival rate was 98.3%, 6 patients (10.2%) ultimately progressed to amputation, and 53 patients (89.8%) were able to continue community ambulation at a mean follow-up time of 15.1 months (SD 9.51, range 1.67-35.2). After arteriography, 2 patients (3.39%) suffered contrast-induced acute kidney injury. No other complications were noted.
English
0032-1052
10.1097/PRS.0000000000005265 [doi]
*Angiography
*Diabetic Foot/su [Surgery]
*Free Tissue Flaps/bs [Blood Supply]
*Lower Extremity/su [Surgery]
*Peripheral Vascular Diseases/dg [Diagnostic Imaging]
*Preoperative Care/mt [Methods]
*Reconstructive Surgical Procedures
Adult
Aged
Aged, 80 and over
Amputation
Diabetic Foot/co [Complications]
Female
Follow-Up Studies
Humans
Lower Extremity/bs [Blood Supply]
Male
Middle Aged
Peripheral Vascular Diseases/co [Complications]
Reconstructive Surgical Procedures/mt [Methods]
Retrospective Studies
Treatment Outcome
MedStar Health Research Institute
MedStar Washington Hospital Center
Surgery/Plastic Surgery
Surgery/Vascular Surgery
Journal Article
BACKGROUND: In patients with lower extremity wounds, free tissue transfer is often the last option before amputation, making it crucial to optimize preoperative planning in order to prevent flap breakdown. No consensus exists regarding preoperative vascular work ups before lower extremity free tissue transfer. Here we analyzed the utility of using arteriography for lower extremity free flap planning. CONCLUSIONS: Preoperative lower extremity arteriography aids in the diagnosis of peripheral vascular disease, allows for timely endovascular intervention, and allows for optimal flap recipient vessel selection with a low complication rate. METHODS: A retrospective review was performed of 57 patients who underwent lower extremity arteriography and 59 free flap operations for lower extremity wounds between November 2014 and August 2017. Findings were used to guide flap recipient vessel selection. Arterial pathology was addressed via endovascular intervention, where appropriate. Encountered pathology was described and patient demographics, comorbidities, and outcomes were analyzed for correlation with abnormal angiographic studies. RESULTS: Angiographic abnormalities were observed in 40 patients (67.8%), including 23 (57.5%) with stenosis/occlusion, 20 (50.0%) with atretic/non-visualized vessels, and 11 (27.5%) requiring endovascular intervention. Stenosis/occlusion was detected in 9 patients (15.3%) with no previously known arterial disease, leading to a new diagnosis of peripheral vascular disease. Flap survival rate was 98.3%, 6 patients (10.2%) ultimately progressed to amputation, and 53 patients (89.8%) were able to continue community ambulation at a mean follow-up time of 15.1 months (SD 9.51, range 1.67-35.2). After arteriography, 2 patients (3.39%) suffered contrast-induced acute kidney injury. No other complications were noted.
English
0032-1052
10.1097/PRS.0000000000005265 [doi]
*Angiography
*Diabetic Foot/su [Surgery]
*Free Tissue Flaps/bs [Blood Supply]
*Lower Extremity/su [Surgery]
*Peripheral Vascular Diseases/dg [Diagnostic Imaging]
*Preoperative Care/mt [Methods]
*Reconstructive Surgical Procedures
Adult
Aged
Aged, 80 and over
Amputation
Diabetic Foot/co [Complications]
Female
Follow-Up Studies
Humans
Lower Extremity/bs [Blood Supply]
Male
Middle Aged
Peripheral Vascular Diseases/co [Complications]
Reconstructive Surgical Procedures/mt [Methods]
Retrospective Studies
Treatment Outcome
MedStar Health Research Institute
MedStar Washington Hospital Center
Surgery/Plastic Surgery
Surgery/Vascular Surgery
Journal Article