Free flap reconstruction after recent lower limb revascularization: a matched cohort analysis of safety and limb salvage outcomes.

BACKGROUND

Free flap reconstructions of the lower extremity in patients requiring prior vascular intervention remains challenging. Restoration of adequate blood flow is essential for flap survival and limb salvage, yet compromised recipient vessels may increase perioperative risk. This study compares outcomes of microvascular lower limb salvage following recent vascular intervention with matched controls without prior revascularization.

PATIENTS AND

METHODS

A retrospective two-centre matched cohort study was conducted including all lower limb free flap reconstructions performed between 2006 and 2024. Patients who underwent significant vascular interventions in the same limb within 100 days prior to reconstruction were identified and matched 1:1 with controls.

RESULTS

Of the screened 821 reconstructions, 34 patients (4.1%) had undergone recent vascular intervention, predominantly percutaneous transluminal angioplasty (82.4%). Operative time was significantly longer in vasculopathic patients (456 vs. 364 min; p=0.003). Flap success was 88.2% in the intervention group versus 100% in controls (p=0.13). All flap losses (n=4) occurred when microvascular anastomoses were performed on the same vessel that previously underwent vascular intervention, corresponding to a 28.6% failure rate in this subgroup (p<0.03). Overall secondary amputation rates were identical in both groups (5.9%). Limb salvage was ultimately achieved in 94.1% of vasculopathic patients.

CONCLUSIONS

When managed within a specialised multidisciplinary setting, free flap reconstruction after recent vascular intervention is feasible and enables limb salvage in the vast majority of cases, despite increased operative complexity and a trend towards higher flap-related complications. Accordingly, these patients should not be denied gold standard treatment solely based on concerns about microvascular challenges.