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Objectives. To evaluate the feasibility and long-term outcome of distal arterial reconstruction combined with free muscle flap transfer for patients who would otherwise have undergone major amputation. Methods. Between 1996 and 2001, 27 reconstructions using autologous vein were performed in 25 patients. Seventeen of these patients had diabetes mellitus. Gracilis, rectus abdominis and latissimus dorsi muscles were used as free flaps, covered with split-thickness skin grafts. Results. Eighty-five percent of patients had a patent graft and viable muscle flap after 1-month. Mean follow-up was 51 months (4–72 months). At the time of follow-up 77% of reconstructions were patent and 70% of patients regained full functional capacity of their lower extremities. Conclusion. Limb-salvage by distal arterial reconstruction and free muscle flap transfer, is feasible with low mortality and morbidity and provides excellent long-term results with regard to graft patency and functional status.

Objectives : to establish if access to distal arterial reconstructive surgery is equally distributed within the health boards of Scotland and to establish if any variations in practice are reflected in lower limb amputation. Methods : a retrospective, descriptive study using hospital discharge data (Scottish Morbidity Record-1) from 1989 to 1999. Results : the rate of distal arterial reconstruction in Scotland increased from 0.9 per 100 000 population in 1989, peaked at 2.6 per 100 000 in 1994 and has since declined steadily to 1.6 per 100 000 in 1999. There was up to 17-fold variation in annual rates of distal reconstruction between the 12 mainland health boards. The variations in distal reconstruction between the health boards were not reflected in variations in amputation rate nor is the decline in distal reconstruction easily explained by increased angioplasty. Conclusions : rates of distal arterial reconstruction in Scotland fall well below those in other European countires. It is likely that insufficient distal operations are undertaken to sufficiently impact on amputation rates. The study recommends an increased provision of specialist vascular surgical expertise in Scotland.