Salvage of femoropedal bypass graft complicated by interval gangrene and vein graft blowout using a flow-through radial forearm fasciocutaneous free flap.
We report the case of a 71-year-old man who had interval gangrene of his calf with subsequent vein graft blowout 3 months after undergoing a femoral-to-dorsalis pedis saphenous vein bypass grafting procedure. To provide wound coverage, restore vascular continuity, and preserve functional ambulation, a flow-through radial forearm fasciocutaneous free flap was interposed between cut ends of the bypass graft. Venous drainage of the flap was from the cephalic vein to the popliteal vein. At 1 month after the operation, the patient had complete wound healing and began to ambulate. At 11 months an asymptomatic high-grade stenosis in the distal radial artery segment of the reconstruction was successfully treated with percutaneous angioplasty. After 22 months of follow-up there have been no further complications, and the patient continues to have full, functional ambulation. The radial forearm flow-through free flap allows single-stage restoration of bypass graft continuity and coverage of extensive, complex tissue defects. This technique represents a novel approach to this difficult problem and provides a viable alternative to major limb amputation.
Gooden
M A
MA
Section of Vascular Surgery, Arizona Health Sciences University, Tucson, USA.
Gentile
A T
AT
Demas
C P
CP
Berman
S S
SS
Mills
J L
JL
D000368:Aged; D003925:Diabetic Angiopathies / Q000150:complications / Q000601:surgery; D005263:Femoral Artery / Q000601:surgery*; D005734:Gangrene / Q000601:surgery*; D006801:Humans; D007866:Leg / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications; D012501:Saphenous Vein / Q000637:transplantation*; D013524:Surgical Flaps; D014656:Vascular Surgical Procedures