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CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(05): 696-700
DOI: 10.1055/s-0042-1756341
Extremity/Lymphedema: Case Report

Free Flap Salvage in the Ischemic Foot: A Case Report

Dongkyung Seo 
1   Department of Plastic and Reconstructive Surgery, Sapporo City General Hospital, Sapporo, Japan
,
Yutaka Dannnoura 
2   Lower Limb Rescue Department, Sapporo City General Hospital, Sapporo, Japan
3   Department of Cardiovascular Medicine, Sapporo City General Hospital, Sapporo, Japan
,
Riku Ishii 
1   Department of Plastic and Reconstructive Surgery, Sapporo City General Hospital, Sapporo, Japan
,
Keisuke Tada 
1   Department of Plastic and Reconstructive Surgery, Sapporo City General Hospital, Sapporo, Japan
,
Kunihiro Kawashima
1   Department of Plastic and Reconstructive Surgery, Sapporo City General Hospital, Sapporo, Japan
,
Tetsunori Yoshida
1   Department of Plastic and Reconstructive Surgery, Sapporo City General Hospital, Sapporo, Japan
,
Katsumi Horiuchi 
1   Department of Plastic and Reconstructive Surgery, Sapporo City General Hospital, Sapporo, Japan
2   Lower Limb Rescue Department, Sapporo City General Hospital, Sapporo, Japan
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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.

Keywords

limb salvage - critical limb ischemia - revascularization

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.




Publication History

Received: 13 June 2021

Accepted: 24 May 2022

Article published online:
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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