Possibilities of revascularization using a free muscle flap in patients with critical lower limb ischemia of different distal arterial lesions etiologies

Introduction. In some patients with critical limb ischemia, direct revascularization is not feasible due to the absence of an adequate distal arterial bed (no-option). The purpose of the study. To evaluate the effectiveness of revascularization using free muscle flap transfer in patients with critical lower limb ischemia of various etiologies. Materials and methods of research. A retrospective analysis was conducted on 37 patients (10 with throm boangiitis obliterans [Buerger’s disease], 15 with diabetes mellitus, and 12 with atherosclerosis of the lower limb arteries) operated on between 2016 and 2025, who underwent lower limb revascularization using free muscle flaps (gracilis, latissimus dorsi). Treatment results. The overall technical success rate was 62 % (23 of 37 patients): 90 % in the Buerger’s disease group, 75 % in the atherosclerosis group, and 33,3 % in the diabetes group. The one-year limb salvage rate was 88,9 %, 77,8 %, and 80 %, respectively, with an overall limb salvage rate of 82.6 %. The mean follow-up period was 29,7 months (M ± SD: 29,7 ± 24,9 months, n = 19), with the longest follow-up exceeding 9 years. The presence of neovascularization in tissues surrounding the transferred flap was confirmed histologically. Conclusion. Indirect or combined revascularization using a free muscle flap is a valuable alternative to major amputation in no-option critical limb ischemia patients. Further research is warranted, particularly in diabetic patients.