Orthoplastic Limb Salvage Using Transtibial Transport and Free-Flap Reconstruction in Patients With Diabetes-Related Chronic Limb-Threatening Ischemia.
Johnson Boey, Jingjing Wen, Zhegang Zhou
✦ AI-curated · Sources linked
Case in brief
A 56-year-old man with poorly controlled diabetes and severe peripheral arterial disease developed a chronic foot ulcer with toe gangrene despite unsuccessful revascularization, leaving no conventional revascularization option. Following radical debridement and ray amputation, he received culture-directed antibiotics and negative-pressure wound therapy. Transtibial transport was used to improve microcirculation; after infection control and wound stabilization, an anterolateral thigh perforator free flap with flow-through microsurgical reconstruction provided coverage while preserving distal perfusion. At 12 months, the flap was viable, the wound fully epithelialized without recurrent ulceration, foot architecture was preserved, and he walked independently with protective footwear.
What made this case unusual
The limb-salvage approach combined transtibial transport to improve microcirculation with a flow-through free flap designed to provide durable coverage while preserving distal perfusion in a patient with no feasible conventional revascularization option.
Diagnostic / clinical pearl
In this case of no-option chronic limb-threatening ischemia, combining a microcirculation-enhancing procedure with flow-through free-flap reconstruction achieved wound healing and functional limb preservation after failed revascularization.