Limb salvage with microvascular free flap reconstruction using simultaneous polytetrafluoroethylene graft for inflow

Microvascular free flaps have been successfully used to cover defects of the lower extremity. In patients with peripheral vascular disease and lower extremity defects, revascularization with in situ or reversed saphenous vein bypass graft combined with microvascular tissue transfer can salvage a limb that would otherwise be amputated. However, some of these patients may not have autologous vein available for the bypass procedure. We present a case of a 69-year-old man who underwent revascularization with a long polytetrafluoroethylene (PTFE) graft and a simultaneous microvascular free flap reconstruction using the PTFE graft as the inflow. The patient had undergone coronary artery bypass graft with saphenous vein and experienced a nonhealing wound of the distal saphenous vein harvest site and exposure of 8 cm of tibia. Angiogram revealed a significant stenosis of the common iliac artery, occluded superficial femoral artery, faint filling of the profunda femoris artery, and a faintly reconstituted posterior tibial artery. Because the patient had no available saphenous vein for bypass, he underwent an axillary-profunda and profunda-posterior tibial artery bypass with PTFE. A rectus abdominus microvascular free flap with direct anastomosis of the inferior epigastric artery to the PTFE was used to cover the exposed bone. The patient currently ambulates without difficulty. Limb salvage using bypass with PTFE combined with simultaneous microvascular free flap reconstruction is possible in selected patients.