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Management of hypovascularized wounds not responding to conventional therapy by means of free muscle transplantation.

BACKGROUND
Chronic ulceration as a complication of arteriosclerotic disease, venous congestion or diabetes mellitus is still a serious clinical problem, resulting in immobilization, extended hospitalization and cost-intensive treatment. Other than standard conservative treatment protocols or early amputation, microsurgical free transfer of well vascularized muscle tissue onto chronic wounds can induce angiogenesis and improve wound healing even in the hypovascularized wound.


PATIENTS
From 1993-1999 we treated 12 patients (mean age: 46 years) with vascular ulcers of the lower extremity with free muscle or fasciocutaneous tissue transfer.


RESULTS
The average hospitalization was 51.4 days. The perioperative mortality was zero. In one patient with factor V deficiency a partial flap necrosis occurred. Two revisions of the micro anastomoses had to be performed. Two seromas occurred at the donor site. No secondary flap loss was observed. Extremity or stump length preservation was achieved in all cases.


CONCLUSIONS
Optimal postoperative treatment with physiotherapy and orthopaedic shoe support is important. If all these factors are present and if the patient is highly motivated a reintegration into normal life can be achieved.