Limb Salvage for Chronic Lower Extremity Wounds

Learning Objectives: After studying this article, the participant should be able to: 1. Describe perioperative management and a multidisciplinary approach to limb salvage and functional limb restoration. 2. Summarize preoperative strategies to optimize patients for limb salvage procedures. 3. Discuss the indications for limb salvage versus amputation. 4. Develop an operative plan for limb salvage that is patient and defect centered and emphasizes the goal of functional limb restoration. 5. Understand adjunct biomechanical procedures and technical considerations to optimize functional outcomes following limb salvage. Summary: This article highlights principles and evolving concepts in limb salvage for chronic lower extremity wounds. Limb salvage is an increasingly important topic, as chronic lower extremity wounds associated with diabetes and/or peripheral vascular disease increase morbidity and long-term mortality rates, decrease quality of life, and contribute to substantial health care costs. The goal of a contemporary reconstructive approach to limb salvage is functional limb restoration. This concept involves optimizing function and minimizing residual disability. In this article, the authors review key concepts in the multidisciplinary approach to patients with limb-threatening lower extremity wounds and introduce the concept of end-stage limb disease. The indications to guide surgical decision-making for limb salvage versus functional amputation are discussed. A patient- and defect-centered reconstructive approach is delineated, with representative case examples provided. Recent developments, such as supermicrosurgical techniques, are also highlighted. Finally, the authors detail important considerations to facilitate success in this complex and challenging patient population, including microvascular technique, adjunct biomechanical operations, flap selection, and recipient vessel selection.