PMID- 36547018
OWN - NLM
STAT- MEDLINE
DCOM- 20230209
LR  - 20230209
IS  - 1098-2752 (Electronic)
IS  - 0738-1085 (Linking)
VI  - 43
IP  - 2
DP  - 2023 Feb
TI  - Two stages of salvaging an extensively necrotic foot with chronic 
      limb-threatening ischemia by arterialization of great saphenous vein and free 
      latissimus dorsi musculocutaneous flap transfer for wound coverage with the 
      arterialized vein as the recipient vessel: A case report.
PG  - 166-170
LID - 10.1002/micr.31001 [doi]
AB  - Patients with chronic limb-threatening ischemia (CLTI) without other options for 
      adequate arterial revascularization could undergo deep (or distal) venous 
      arterialization for limb salvage. Additionally, patients with extensive foot 
      wound with CLTI sometimes require free flap transfer for limb salvage. We herein 
      report a case of successful reconstructive limb-salvage surgery for an 
      extensively necrotic foot with CLTI, using a two-stage operation involving venous 
      arterialization using foot-perforating veins and subsequent free flap transfer 
      (with preservation of the arterialized vein). The patient was a 59-year-old man 
      with CLTI. The patient's right foot had dry necrotic tissue after Lisfranc joint 
      amputation. Only one straight-line to the posterior tibial artery was achieved 
      after endovascular therapies (four times). At the first stage of surgery, an 
      arterial-venous shunt bypass from the superficial femoral artery to the distal 
      great saphenous vein (GSV) (near the foot-perforating vein) was created. Arterial 
      blood supply reached the necrotic area via the foot venous circulation system. At 
      the second stage of surgery, free latissimus dorsi musculocutaneous flap 
      (8 x 27 cm) transfer with preservation of the arterialized vein was performed. 
      The pedicle artery was anastomosed to the bypass graft (end-to-side). The pedicle 
      vein was anastomosed to the proximal stump of the GSV (end-to-end). The flap and 
      residual foot survived completely, at a one-year follow-up postoperatively. An 
      indocyanine green bypass-through angiography revealed the angiosome through the 
      venous arterialization bypass graft, which included the flap; entire forefoot; 
      and partial regions of the midfoot and heel. This two-stage operation might be 
      considered a useful option for limb-salvage and complete wound-healing in 
      patients with severe non-healing wound with CLTI. The two methods could 
      compensate and overcome the problems of either method: incomplete wound-healing 
      after venous arterialization, and the absence of a recipient artery for free flap 
      transfer.
CI  - (c) 2022 Wiley Periodicals LLC.
FAU - Kagaya, Yu
AU  - Kagaya Y
AUID- ORCID: 0000-0003-3285-5428
AD  - Department of Plastic and Reconstructive Surgery, Kyorin University Hospital, 
      Tokyo, Japan.
FAU - Ohura, Norihiko
AU  - Ohura N
AD  - Department of Plastic and Reconstructive Surgery, Kyorin University Hospital, 
      Tokyo, Japan.
FAU - Miyamoto, Akira
AU  - Miyamoto A
AD  - Department of Cardiovascular Medicine, Takatsu Chuo Hospital, Kanagawa, Japan.
FAU - Ozaki, Mine
AU  - Ozaki M
AD  - Department of Plastic and Reconstructive Surgery, Kyorin University Hospital, 
      Tokyo, Japan.
LA  - eng
PT  - Case Reports
DEP - 20221222
PL  - United States
TA  - Microsurgery
JT  - Microsurgery
JID - 8309230
SB  - IM
MH  - Male
MH  - Humans
MH  - Middle Aged
MH  - Saphenous Vein/transplantation
MH  - Chronic Limb-Threatening Ischemia
MH  - *Myocutaneous Flap/surgery
MH  - *Superficial Back Muscles/transplantation
MH  - Treatment Outcome
MH  - Limb Salvage/methods
MH  - Ischemia/surgery
MH  - *Peripheral Arterial Disease/surgery
EDAT- 2022/12/23 06:00
MHDA- 2023/02/10 06:00
CRDT- 2022/12/22 09:44
PHST- 2022/11/18 00:00 [revised]
PHST- 2022/07/16 00:00 [received]
PHST- 2022/12/14 00:00 [accepted]
PHST- 2022/12/23 06:00 [pubmed]
PHST- 2023/02/10 06:00 [medline]
PHST- 2022/12/22 09:44 [entrez]
AID - 10.1002/micr.31001 [doi]
PST - ppublish
SO  - Microsurgery. 2023 Feb;43(2):166-170. doi: 10.1002/micr.31001. Epub 2022 Dec 22.