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Expanding Criteria for Limb Salvage in Comorbid Patients with Nonhealing Wounds: The MedStar Georgetown Protocol and Lessons Learned after 200 Lower Extremity Free Flaps | Journal CME
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Availability
On-Demand
Expires on Jul 21, 2028
Credit Offered
1 CME Credit
0.5 Patient Safety Credit

"Expanding Criteria for Limb Salvage in Comorbid Patients with Nonhealing Wounds: The MedStar Georgetown Protocol and Lessons Learned after 200 Lower Extremity Free Flaps" presents an institutional protocol for performing free tissue transfer in patients with complex comorbidities, such as diabetes and peripheral vascular disease, who were traditionally not considered good candidates for limb salvage. Analyzing 200 consecutive cases from 2011 to 2019, the study demonstrates that with a standardized, multidisciplinary approach—incorporating preoperative hypercoagulability testing, angiography with possible intervention, and venous ultrasound—high success rates (up to 98%) in flap viability can be achieved despite poor patient prognostic indicators. The authors detail improvements over time, such as reduced operative time, increased flap success, and fewer amputations in later cases, underscoring the importance of institutional learning and protocol evolution. By showcasing the MedStar Georgetown experience, the study advocates for expanding the indications for limb salvage in high-risk populations, emphasizing that standardized perioperative care and team-based planning can overcome the barriers posed by severe comorbidities.

 

The Accreditation Council for Continuing Medical Education (ACCME) accredits ASPS to provide educational activities and material with Category 1 CME credits. As an official CME provider, ASPS must comply with all ACCME standards, as outlined in the ACCME Standards for Integrity and Independence in Accredited Continuing Education.

 

Intended Audience

This educational activity is intended for plastic surgery practitioners, residents, and other healthcare professionals interested in translating expanded knowledge into practice for the improvement of patient outcomes in plastic and reconstructive surgery.

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Nigam, Manas M.D.; Zolper, Elizabeth G. B.S.; Sharif-Askary, Banafsheh M.D.; Abdou, Salma A. M.D.; Charipova, Karina B.S.; Bekeny, Jenna C. B.A.; Fan, Kenneth L. M.D.; Steinberg, John S. D.P.M.; Attinger, Christopher E. M.D.; Evans, Karen K. M.D.

Plastic and Reconstruction Surgery®Editors: Editor-in-Chief: Kevin Chung, MD
Co-Editor: Amy Colwell, MD
Section Editors: Charles E. Butler, MD

CME Faculty
Jarrod T. Bogue, MD, FACS
Bharat Ranganath, MD

After viewing this course, the participant should be able to:

  1. Recognize the evolving criteria for limb salvage in patients with chronic, nonhealing lower extremity wounds, particularly in those with significant comorbidities such as diabetes, vascular disease, and thrombophilic disorders.
  2. Discuss the role of comprehensive preoperative assessment—including vascular imaging and hypercoagulability workup—in patient selection and surgical planning for lower extremity free tissue transfer.
  3. Describe strategies to optimize arterial inflow and venous outflow to improve success rates in microsurgical limb salvage procedures.
  4. Evaluate the benefits and costs of standardized, multidisciplinary protocols in improving outcomes, reducing complications, and expanding eligibility for limb salvage in complex patients.
  5. Apply evidence-based principles to determine candidacy for limb salvage versus primary amputation in patients with severe limb-threatening wounds and systemic risk factors.
The American Society of Plastic Surgeons (ASPS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Designation
The ASPS designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™️. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Recognition Statement
The Continuing Medical Education (CME) credits offered by this activity are enhanced by ASPS Learner Credit Reporting for learners who have opted into this reporting. Successful completion of this CME activity enables active American Board of Surgery (ABS) members the opportunity to earn credit toward the CME requirement of the ABS's Continuous Certification program when claimed within 30 days of completion of the activity.

Participants in ASPS-accredited education who want their CME credits reported to certifying and state licensing boards must opt-into reporting and add their NPI as well as state license ID and/or collaborating board ID(s) before claiming credit.

Disclosure Policy
The American Society of Plastic Surgeons (ASPS) requires all instructors, planners, reviewers, managers and other individuals in a position to control or influence the content of an activity to disclose all relevant financial relationships or affiliations. All identified conflicts of interest must be resolved and the educational content thoroughly vetted by ASPS for fair balance, scientific objectivity and appropriateness of patient care recommendations. ASPS also requires faculty/authors to disclose when off-label/unapproved uses of product are discussed in a CME activity or included in related materials.

Disclaimer: All relevant financial relationships for planners, faculty and others in control of content (either individually or as a group) are reviewed by the ASPS Continuing Education Committee and have been mitigated, if applicable.

The following faculty and contributors have no relevant financial relationships or affiliations to disclose:

No relevant disclosures

AMA PRA Category 1 CreditTM: 1.0
Media: Journal Article
Release Date:  (7/21/2025)
Expiration Date: (7/21/2028)
Estimated time to complete this course: 1 hour
*Course access ends on course expiration date

Directly provided by the American Society of Plastic Surgeons® (ASPS®)

For Physician Assistants and Nurse Practitioners, these credits have been designated as AMA PRA Category 1 Credits™ by an ACCME-accredited organization and are applicable to these certifications. These credits/hours may be applicable to your profession. Check PlasticSurgery.org/CME for more information.