Vnitr Lek 2005, 51(3):292-298

Chronic critical limb ischaemia - distal revascularisation vs distal revascularisation with free muscular transfer

B. Zálešák^1,*, P. Tošenovský², I. Čižmář³, J. Zapletalová⁴, M. Šimek⁵

¹ Klinika popálenin a rekonstrukční chirurgie Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Pavel Brychta, CSc. a oddělení plastické a estetické chirurgie FN, Olomouc, přednosta MUDr. Pavel Hartl

² Klinika transplantační chirurgie IKEM, Praha, přednosta doc. MUDr. Miroslav Ryska, CSc.

³ Oddělení úrazové chirurgie, FN Brno, pracoviště Bohunice, přednosta doc. MUDr. Michal Mašek CSc.

⁴ Ústav biofyziky a biometrie Lékařské fakulty UP, Olomouc, přednosta prof. Ing. Jan Hálek, CSc.

⁵ Kardiochirurgická klinika Lékařské fakulty UP a FN, Olomouc, přednosta doc. MUDr. Petr Němec, CSc.

The study compares treatment results in two groups of patients with critical limb ischaemia:
the group A - 21 patients treated only with the pedal bypass is compared with the group B - 17 patients treated with the pedal bypass and free microsurgical muscular transfer covered with dermoepidermal graft. Primary/secondary one-year patency in the first group was 64.7/82.4% and 54.5/81.8% in the second group, respectively. Evaluation of the patency at the end of the study by means of the survival analysis together with construction of Kaplan-Meier survival curves and long-rank test did not prove significantly relevant difference between the two groups (p = 0.14). No statistically significant differences were found even in the number of relapses, amputations and deaths. Even though combined surgery is incomparably more demanding for surgical team, it represents substantially higher stress for a patient and it is performed in conditions of more extensive peripheral affection of the limb than pedal bypass only, it is not related with the higher number of relapses, amputations nor higher mortality. It is unjustifiable to deny this surgery to the patients in higher age groups with associated diseases and to use possible risks of this demanding surgery as a reasoning of the denial. Pedal bypass and muscular transfer represent the last possibility of saving a limb and keeping bipedal walking for these patients.

Keywords: critical ischaemia; pedal bypass; free muscular flap; preservation of the limb

Received: March 10, 2004; Accepted: May 4, 2004; Published: March 1, 2005  Show citation