Use of Novel Alternative Treatment Options for Lower Extremity Limb Salvage

Introduction: Lower extremity wounds are particularly challenging and can be attributed to a multitude of etiologies including traumatic accidents, chronic medical conditions, tobacco usage, and oncologic resections. Treatment options vary from simple closure to complex microvascular free tissue transfer. The use of meshed human reticular acellular dermis (mHRAD) in conjunction with dehydrated human amnion and chorion matrix (dHACA) offers another treatment option in the armamentarium for the limb salvage specialist.Methods:A retrospective review of all patients undergoing lower extremity reconstruction by a single surgeon was performed from 2017-2023. All patients undergoing surgical treatment for lower extremity wounds were evaluated for extent of surgery, operative complications, and success of limb salvage. Patient demographics and medical comorbidities were also assessed to determine additional contributing factors for failure.Results:A total of 230 operations were performed for reconstruction of lower extremity defects and wounds. Forty patients underwent reconstruction with reconstruction with pedicled muscle or musculocutaneous flaps with fifteen patients requiring free flaps while the remaining patients were treated with local tissue flaps, skin grafts, and wound matrices. In thirty-one cases, mHRAD and dHACA were used with one failure (n=1, 3.2%). This patient required an above knee amputation due to an infected total knee prosthesis after undergoing a pedicled gastrocnemius muscle flap, a pedicled reverse anteriolateral thigh musculocutaneous flap, and two free latissimus dorsi muscle flaps. The remaining two patients required a below knee amputation, one due traumatic degloving of the anterior foot and heel and the second in an active smoker with chronic osteomyelitis and infected hardware in the ankle.Discussion: Amputation is the most dreaded complication as a result of lower extremity wounds. Although complex reconstruction with autologous tissue flaps may be possible, the advent of novel human allografts provides an alternative treatment. These new wound matrices may provide another option for this patient population to preserve the lower limb.References: