A challenging treatment for an ischaemic ulcer in a patient with Buerger's disease: vascular reconstruction and local flap coverage.
An ischaemic heel ulcer in a patient with Buerger's disease was reconstructed using an in situ saphenous vein graft combined with a local flap. The bypass was sufficient to restore blood supply to the ischaemic limb but a flap was necessary to cover the persistent heel ulcer, which remained after revascularisation. One month after bypass surgery the ulcer was debrided and the resulting defect was covered with a lateral supramalleolar flap. The postoperative course was uneventful and the flap donor site healed well. When treating ischaemic ulcers in a patient with Buerger's disease, vascular reconstruction should be considered first in order to salvage the limb. After revascularisation, a local flap can be used to cover a persistent defect but very few local flaps have been reported. This report is the first published case of successful local flap transfer after bypass surgery in a patient with Buerger's disease. We think that a local flap is one possible treatment for a non-healing ulcer after revascularisation.
Chang
H
H
Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine, Mitaka City, Tokyo, Japan.
Hasegawa
T
T
Moteki
K
K
Ishitobi
K
K
D005260:Female; D005500:Follow-Up Studies; D016523:Foot Ulcer / Q000209:etiology / Q000601:surgery*; D006365:Heel / Q000098:blood supply / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery*; D008875:Middle Aged; D012501:Saphenous Vein / Q000637:transplantation*; D013524:Surgical Flaps; D013919:Thromboangiitis Obliterans / Q000150:complications*; D014656:Vascular Surgical Procedures / Q000379:methods