[The nutrient flap. Its application in saving lower limbs involved in stage IV arteritis]

Area of Science:

• Vascular Surgery
• Reconstructive Microsurgery
• Arteriosclerosis Treatment

Context:

• Advanced stage IV lower limb arteriosclerosis presents challenges for traditional revascularization.
• Nutrient flaps are typically considered accessory for skin coverage but play a vital role in specific vascular procedures.
• Preserving limb viability and function is paramount when conventional methods fail.

Purpose:

• To evaluate the efficacy of the nutrient flap in treating critical limb ischemia due to advanced arteriosclerosis.
• To describe the surgical technique for applying a nutrient flap in limb salvage.
• To demonstrate the potential of nutrient flaps to promote neovascularization and avoid high amputation.

Summary:

• The nutrient flap, often raised from the latissimus dorsi and anastomosed to the popliteal artery via a saphenous vein graft, was utilized in four cases of stage IV arteriosclerosis.
• This flap was strategically placed over the distal extremity after debridement of necrotic tissue, providing supplementary blood flow to ischemic zones.
• The procedure successfully induced neovascularization, maintained heel weight-bearing capacity, and averted the need for higher-level amputations.

Impact:

• The nutrient flap serves as a viable limb salvage option in complex arteriosclerosis cases where standard revascularization is not feasible.
• This technique supports the formation of new blood vessels, enhancing tissue survival and function in ischemic extremities.
• Successful application of the nutrient flap preserves the heel, enabling weight-bearing and improving patient mobility post-surgery.