A rational approach to ischemic and ischemic-diabetic foot reconstruction

Abstract

Microsurgical techniques have been well documented to be of great use in reconstruction of post-traumatic defects of the lower extremity. The same techniques are also increasingly useful in reconstruction for chronic atherosclerotic disease of the lower extremities. Extremely small, heavily calcified vessels can be reliably reconstructed using delicate microsurgical techniques and high magnification. Additionally, revascularization followed by microsurgical free tissue transfer has proven to be a valuable alternative to amputation in patients with major soft tissue loss, or bony or tendon lesions requiring soft tissue reconstruction. Although this is an elderly population with a high number of comorbid risk factors, limb salvage can be obtained with a very low morbidity and mortality when carried out in a closely coordinated approach with the appropriate medical and surgical specialists. Microsurgical techniques have greatly expanded the number of patients that can be offered vascular reconstruction, including patients with severely calcified and tiny vessels (1 mm outflow vessels being routinely successful). Minor modifications in microsurgical technique (working with heavy calcification, presence of atherosclerotic plaques) allow these techniques to be applied to the chronic atherosclerotic and diabetic patient population, thus affording broadened horizons of reconstructive possibilities to these patients.