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DOI: 10.1055/s-0042-1756341
Free Flap Salvage in the Ischemic Foot: A Case Report
Abstract
We performed distal bypass and free flap transfer in a single-stage operation to repair an extensive soft tissue defect in an ischemic foot of an 84-year-old woman. The nutrient artery of the free flap was anastomosed to the bypass graft in an end-to-side manner. Subsequently, the bypass graft became occluded on several occasions. Although intravascular and surgical interventions were performed each time, the bypass graft eventually became completely occluded. However, despite late occlusion of the nutrient artery, the free flap has remained viable and the patient is ambulatory. The time required for a transplanted free flap to become completely viable without a nutrient artery is likely longer for an ischemic foot compared with a healthy foot. However, the exact period of time required is not known. A period of month was required in our patient. We report this case to help clarify the process by which a free flap becomes viable when applied to an ischemic foot.
Patient Consent
The patient provided written informed consent for the publication and the use of her images.
Authors' Contributions
Conceptualization: K.H. Data curation: Y.D. Writing - original draft: D.S. Writing - review & editing: D.S., Y.D., R.I., K.T., K.K., T.Y., K.H.
Ethical Approval
This is a case report and we have got approval for publication from our patient and submitted the form at the time of submission of this article.
Publikationsverlauf
Eingereicht: 13. Juni 2021
Angenommen: 24. Mai 2022
Artikel online veröffentlicht:
23. September 2022
© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Meyer A, Goller K, Horch RE. et al. Results of combined vascular reconstruction and free flap transfer for limb salvage in patients with critical limb ischemia. J Vasc Surg 2015; 61 (05) 1239-1248
- 2 Mimoun M, Hilligot P, Baux S. The nutrient flap: a new concept of the role of the flap and application to the salvage of arteriosclerotic lower limbs. Plast Reconstr Surg 1989; 84 (03) 458-467
- 3 Mätzke S, Tukiainen EJ, Lepäntalo MJ. Survival of a microvascular muscle flap despite the late occlusion of the inflow artery in a neuroischaemic diabetic foot. Scand J Plast Reconstr Surg Hand Surg 1997; 31 (01) 71-75
- 4 Igari K, Kudo T, Toyofuku T. et al. Combined arterial reconstruction and free tissue transfer for patients with critical limb ischemia. Ann Vasc Dis 2013; 6 (04) 706-710
- 5 Tanaka K, Igari K, Kishino M. et al. The possibility of free tissue transfer as a nutrient flap for critical ischemic foot: a case report. Microsurgery 2017; 37 (06) 694-698
- 6 Rothaus KO, Acland RD. Free flap neo-vascularisation: case report. Br J Plast Surg 1983; 36 (03) 348-349
- 7 Yoon AP, Jones NF. Critical time for neovascularization/angiogenesis to allow free flap survival after delayed postoperative anastomotic compromise without surgical intervention: a review of the literature. Microsurgery 2016; 36 (07) 604-612