Background: Microvascular surgery plays a major role in the reconstructive process of limb salvage. But microsurgery in the patient with renal disease is still considered a high risk procedure. Some authors have even recommended immediate amputation due to poor long term survival in patients with renal failure and lower limb ischemia.
Methods: A retrospective review of all patients with end-stage renal disease on hemodialysis who underwent free flap surgery at Tzu Chi Dalin General Hospital were included in the study. Data were collected over a 5 year period, between June 2005 and June 2009.
Results: A total of 20 patients were included in the study, of which 11 were males and 9 were female patients. Their average age was 63 years old. All had a history of diabetes mellitus with peripheral vascular disease. Seven out of the twenty patients had undergone prior vascular intervention. The total flap survival rate was 95%. Four patients eventually required major limb amputation, due to progressive infection at the recipient site. There were no further major limb amputations in these patients in the long term follow up. The total limb salvage rate was 80%. The average follow up time was 30 months.
Conclusions: Our present approach shows that the results of limb salvage in this particular group of patients are not as discouraging as previously reported. In the description of patients with renal disease, we suggest that they not be described as one entity but to divide them into subgroups so that this better reflects the risk of surgery and the success of limb salvage.
