title: Successful use of a gastrocnemius flap for an exposed PTFE femorodistal graft: a case report.
abstract: Peripheral vascular disease (PVD) is a condition requiring aggressive management to minimise the associated increased morbidity and mortality. Femoro-distal bypass grafting is used in patients with extensive occlusion affecting the crural arteries and poor limb function, but is associated with infection, wound dehiscence and graft exposure. We report a case of a 73-year-old male with history of PVD and occluded ipsilateral femoro-distal bypass graft who underwent limb salvage surgery with a left 6 mm heparin-bonded polytetrafluoroethylene femoro-distal bypass graft in September 2011. He later presented with exposure of the graft over the lateral aspect of the knee following wound dehiscence. During surgery, the exposed portion of the graft was covered by a lateral gastrocnemius muscle flap with an overlying split thickness skin graft. Minor donor site healing problems were noted, but he otherwise made an excellent recovery. While gastrocnemius muscle flaps have been used to cover soft tissue tibial defects secondary to sarcoma and exposed knee joint prostheses, our case adds to the limited literature demonstrating successful salvage of an exposed synthetic graft as a viable alternative to amputation. We therefore recommend prompt referral to plastic services for the management of these complex wounds.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital.
authors.forename: W M
authors.initials: WM
authors.lastname: Nabulyato
authors.forename: H
authors.initials: H
authors.lastname: Alsahiem
authors.forename: K
authors.initials: K
authors.lastname: Szepelak
authors.forename: J R
authors.initials: JR
authors.lastname: Boyle
authors.forename: C M
authors.initials: CM
authors.lastname: Malata
mesh_terms: D000368:Aged; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D023821:Limb Salvage / Q000379:methods; D008297:Male; D018482:Muscle, Skeletal / Q000637:transplantation*; D016491:Peripheral Vascular Diseases / Q000150:complications*; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D013524:Surgical Flaps / Q000009:adverse effects; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000601:surgery; D019737:Transplants; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D011138:Polytetrafluoroethylene
keywords: exposed PTFE femoro-distal graft; gastrocnemius flap; limb salvage; peripheral vascular disease