The limited value of preoperative angiography in microsurgical reconstruction of the lower limb

Biplanar angiography has been a prerequisite in microvascular reconstruction of the lower extremity. While defining arterial anatomy, the procedure is not without morbidity. More important, angiography does not determine the acceptability of arterial blood flow through a particular recipient vessel. The purpose of this study was to evaluate the safety of microvascular tissue transplantation for reconstruction of complex lower-limb wounds, without preoperative angiography. A consecutive series of 48 patients undergoing tissue transplantation for complex wound reconstruction during a recent 8-month period is presented. Sixty percent of patients had soft-tissue wounds classified as Gustilo IIIB preoperatively, although 89 percent of wounds ultimately arose from trauma. Preoperative and intraoperative clinical assessment of recipient vessels allowed successful reconstruction in all but one case. The only loss of a transplant arose as a result of venous outflow obstruction, a situation not to be improved by preoperative angiography. In no instance was a patient explored and reconstruction deferred due to inadequate recipient vasculature. The results of this study support microvascular tissue transplantation to lower-limb wounds without preparatory angiography in almost all circumstances. Adequate clinical parameters are presented for determining recipient pedicle status, both preoperatively and intraoperatively.