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.

Limb salvage techniques using free tissue transfer (FTT) in patients with chronic wounds due to long standing osteomyelitis, diabetes, and peripheral vascular disease(PVD) are technically challenging. The Longitudinal Slit Arteriotomy End to Side Anastomosis(LS-ETSA) is our preferred technique because it is the least invasive arteriotomy which is especially important for diseased recipient arteries. We reviewed our highly comorbid patients who underwent FTT with this technique to understand the success rates, overall outcomes and long-term limb salvage rates.A retrospective review was performed to analyze outcomes of FTT using LS-ETSA between 2012 and 2018 by the senior surgeon.115 free flaps were identified. Patients were on average 55.9 years old, BMI 29.2 kg/m. Etiologies included: osteomyelitis(83.5%), hypertension(60.9%), tobacco use(46.1%), diabetes(44.3%), PVD(44.3%), hypercoagulability(35.7%), arterial calcifications(17.4%). Overall flap success was 93.0%. 27.8% required reoperation in the perioperative period due to complications. On univariate analysis, DM, HTN, and hypercoagulability were significantly associated with the eventual need for amputation(p < 0.05). Multivariate analysis showed that intra-operative thrombosis and take back was independently associated with flap failure. There was an overall limb salvage rate of 83.5%, and of those salvaged, 92.7% were ambulating without a prosthesis at a mean follow up time of 1.53 years.We present the largest series of LS-ETSA for patients undergoing FTT for limb threatening defects in the compromised host. Overall flap success, limb salvage rates and functional outcomes are high using this technique.