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Endovascular Revascularization and Free Flap Salvage of Diabetic Foot Ulcers

Severe diabetic foot wounds often demand more than wound care or debridement alone. This lecture presents a treatment strategy built around restoring blood flow first and then providing reliable soft-tissue coverage, with real cases of gangrene, necrotizing infection, critical limb ischemia and complex tissue loss.

The speaker explains how ABI/PVR and angiography guide revascularization, why endovascular treatment has largely replaced open bypass in their practice, and how reconstruction is coordinated with vascular surgeons. Several cases demonstrate the use of rectus femoris and vastus lateralis muscle flaps, with skin grafting and selective use of perforator-based flaps.

Particularly practical are the surgical principles: choosing a soft recipient artery, favoring end-to-side anastomosis to preserve distal flow and collateral circulation, timing free flap reconstruction after angioplasty, and adapting postoperative mobilization to protect the flap. Long-term outcomes are also discussed, including limb salvage after combined revascularization and free tissue transfer—even in patients receiving hemodialysis, where overall survival remains a major challenge.

PRAS-03

Course

Lower Extremity Reconstruction: Limb Salvage, Wound Management, and Functional Outcomes

01 56:14 Chronic Wounds: From Etiology to Surgical ClosureA practical overview of chronic wound assessment, etiological diagnosis, wound-bed preparation, dressings, debridement and reconstructive options, with a focus on evidence-based decision-making.

02 1:05:42 Principles and Goals in Severe Limb Trauma ReconstructionHow do you decide when a severely injured limb should be salvaged—and when primary amputation is the better reconstruction? Dr Hari Venkatramani explores practical decision-making in mangled upper and lower extremities through complex clinical cases, microsurgical reconstruction, debridement, flap coverage and staged functional recovery.

03 1:03:15 Regenerative Peripheral Nerve Interfaces (RPNI) for Neuroma and Phantom Limb PainWhy do neuromas keep returning after amputation, and can we give regenerating axons a better target? Dr. Paul Cederna explains the rationale behind RPNI, its technical principles, clinical results, and its growing role in both treatment and prevention of post-amputation pain.

04 48:10 Now playing Endovascular Revascularization and Free Flap Salvage of Diabetic Foot UlcersA practical case-based lecture on combining endovascular revascularization with free tissue transfer to salvage severely ischemic diabetic feet, with emphasis on timing, recipient vessels and flap selection.

05 1:48:07 Microsurgical Reconstruction of the Lower Extremity in a Level 1 Trauma CenterA case-based lecture on complex lower-extremity trauma, limb salvage, flap selection and microsurgical reconstruction, with a strong focus on function, vascular preservation and practical decision-making.

06 1:06:01 Lower Limb Reconstruction After High-Energy Trauma: Flaps, NPWT and Flap SalvageA practical overview of lower-limb reconstruction after complex trauma: choosing local and free flaps, using negative-pressure wound therapy, monitoring microsurgical flaps and recognizing vascular compromise before salvage becomes unlikely.