title: Salvage of the hand with a free flap in a hemodialysis patient with finger gangrene and ipsilateral arteriovenous fistula: a case report.
abstract: We describe the case of a female with end-stage renal disease who developed a left ischemic hand and index finger gangrene 2 years after commencement of hemodialysis. Ray amputation was performed, however, the surgical wound was complicated by progressive soft tissue necrosis and metacarpal bones exposure. To avoid amputation at a higher level, we repaired the defect successfully with a free anterolateral thigh perforator flap. A radiocephalic arteriovenous fistula, the dialysis access, was divided to provide the recipient vessels. Reconstruction with this method has the advantage of a staged arteriovenous fistula, which can increase the free-flap success rate, and has the potential to improve perfusion of the distal ischemic hand.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung Hsien, Taiwan.
authors.forename: Ching-Hua
authors.initials: CH
authors.lastname: Hsieh
authors.forename: Hui-Hong
authors.initials: HH
authors.lastname: Tsai
authors.forename: Jir-Wen
authors.initials: JW
authors.lastname: Yin
authors.forename: Tsan-Shiun
authors.initials: TS
authors.lastname: Lin
authors.forename: Seng-Feng
authors.initials: SF
authors.lastname: Jeng
mesh_terms: D000368:Aged; D001164:Arteriovenous Fistula / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical / Q000295:instrumentation; D005260:Female; D005385:Fingers / Q000098:blood supply / Q000473:pathology* / Q000601:surgery*; D005734:Gangrene / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000628:therapy; D023821:Limb Salvage; D017534:Radial Artery / Q000473:pathology / Q000601:surgery; D006435:Renal Dialysis; D013524:Surgical Flaps