Free Flap Salvage in the Ischemic Foot: A Case Report

Area of Science:

• Vascular Surgery
• Reconstructive Surgery
• Tissue Engineering

Background:

• Extensive soft tissue defects in ischemic feet pose significant reconstructive challenges.
• Maintaining flap viability in compromised vascular beds is critical for successful limb salvage.

Purpose of the Study:

• To report a case of successful free flap survival in an ischemic foot despite bypass graft occlusion.
• To explore the timeline for free flap vascularization in an ischemic foot without a patent nutrient artery.

Main Methods:

• A single-stage operation involving distal bypass and free flap transfer was performed.
• The free flap's nutrient artery was anastomosed to the bypass graft end-to-side.
• Repeated interventions were performed for recurrent bypass graft occlusion.

Main Results:

• The bypass graft eventually occluded completely.
• Despite complete occlusion of the nutrient artery, the free flap remained viable.
• The patient achieved ambulation with the viable free flap.

Conclusions:

• A free flap can achieve delayed viability in an ischemic foot, even without a patent nutrient artery.
• The time required for this delayed vascularization in ischemic feet may be prolonged.
• This case provides insights into free flap survival mechanisms in challenging ischemic foot reconstructions.