The article reviews modern limb-salvage strategies for chronic lower-extremity wounds, focusing on restoring function while minimizing disability. It outlines a multidisciplinary, patient- and defect-centered approach—introducing “end-stage limb disease,” criteria for choosing salvage versus functional amputation, and emerging options such as supermicrosurgery—along with practical tips on microvascular technique, flap and vessel selection, and complementary biomechanical procedures.

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.

Rajiv P. Parikh, MD, MPHS - Department of Plastic Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center and Georgetown University Hospital 

Justin M. Sacks, MD, MBA-Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine 

Plastic and Reconstruction Surgery®Editors:  
Editor-in-Chief: Kevin Chung, MD
Co-Editor: Amy Colwell, MD
Section Editors: John Y.S. Kim, MD

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.

1. Describe perioperative management and a multidisciplinary approach to limb salvage and functional limb restoration.
2. Summarize preoperative strategies to optimize patients for limb salvage procedures.
3. Discuss the indications for limb salvage versus amputation.
4. Develop an operative plan for limb salvage that is patient and defect centered and emphasizes the goal of functional limb restoration.
5. Understand adjunct biomechanical procedures and technical considerations to optimize functional outcomes following limb salvage.

• Patient Care and Procedural Skills
• Medical Knowledge
• Practice-based Learning and Improvement

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-in to 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 faculty, authors, planners, reviewers, managers, staff 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. The ASPS also requires faculty/authors to disclose when off-label/unapproved uses of a 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 planners/faculty members/reviewers have no relevant financial relationships or affiliations to disclose:
Rajiv P. Parikh, MD, MPHS1 Justin M. Sacks, MD, MBA 

AMA PRA Category 1 Credit^TM1.0
Media: Journal Article, video
Release Date: 6/01/2025
Expiration Date: 6/01/2028
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®)