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Invited Commentary

Lewis J. Levien, MD
Arch Surg. 1996;131(10):1108. doi:10.1001/archsurg.1996.01430220102024.
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The authors are to be congratulated on their success in achieving a remarkable limb salvage rate. The demonstrated relative paucity of locoregional recurrence in the presented series supports their contention that this aspect of disease control is not of major importance in the treatment of this group of patients. The presence of systemic disease at the time of presentation or subsequent systemic recurrence is the factor that will ultimately determine survival. A conservative approach to limb salvage despite bony involvement is therefore to be supported.

I agree entirely with the authors that autologous vein graft remains the graft material of choice for arterial reconstruction below the inguinal ligament, but I continue to use Dacron above the inguinal ligament. I have, however, experienced rapid and extensive deterioration of saphenous vein grafts exposed to large doses of irradiation. For this reason, in cases in which large postoperative doses of radiotherapy are planned,


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