Treatment of recalcitrant venous ulcers with free tissue transfer for limb salvage

Venous leg ulcers (VLUs) are open lesions of the lower limb and are the most severe sequelae of chronic venous insufficiency. Although VLUs can often be treated via a conservative multimodal approach, a subset of patients will develop limb-threatening recalcitrant ulceration. In patients who have exhausted all options short of amputation, microsurgical free tissue transfer has proven to be a valuable means of soft tissue reconstruction. There have been six published case series comprising a total of 74 patients and 84 free flaps for recalcitrant venous ulceration with an overall flap survival rate of 94%. Even though free tissue transfer has been employed successfully, surgeons should proceed with caution as these procedures require prolonged general anesthesia, entail a tenuous immediate postoperative period, and cause significant exposure to the health system as compared to conservative management or even lower extremity amputation.