A Free Bypass Flap for Chronic Limb-threatening Ischemia

Autor: Kohei Umekawa, MD, Takashi Kurabayashi, MD, Hirotaka Asato, MD, Takuya Iida, MD, Ayako Suzuki, MD, Masanori Tasaki, MD
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: Plastic and Reconstructive Surgery, Global Open, Vol 12, Iss 6, p e5875 (2024)
Druh dokumentu: article
ISSN: 2169-7574
00000000
DOI: 10.1097/GOX.0000000000005875
Popis: Background:. Recently, significant inframalleolar disease seems to increase in chronic limb-threatening ischemia (CLTI) patients, making identifying sufficient outflow vessels in the foot challenging. In these difficult situations, free tissue transfer is a valuable tool to provide a low-resistance vascular bed to the affected part. However, there remains concern that free tissue transfer may impede adequate perfusion of the higher resistance diseased vascular bed. Methods:. To improve perfusion of the affected area directly, the authors have developed a concept of a free bypass flap, adding bypass surgery to free tissue transfer. After anastomosis with the recipient vessels in a conventional manner for free tissue transfer, bypass surgery to the foot is performed by anastomosis of the branch of the flap pedicle with the diseased artery to the foot. A retrospective chart review of nine CLTI patients was performed to analyze the outcomes of free bypass flap transfer between 2018 and 2023. Results:. The flap success rate was 100% (n = 9). Postoperative angiography or echo confirmed the patency of all but one bypass vessel (n = 8). There were six fatalities, however, due to causes other than foot lesions, with an average observation period of 16 months. The limb salvage rate was 89% (n = 8). Conclusions:. A free bypass flap enhances the overall blood circulation to the foot. Due to its high patency rate of bypass vessels, it is a valuable method for preserving the limbs of highly comorbid patients with CLTI.
Databáze: Directory of Open Access Journals
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