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Case Reports
. 2022 Aug 11;2022(8):rjac320.
doi: 10.1093/jscr/rjac320. eCollection 2022 Aug.

Lower limb re-vascularization based on the angiosome concept with immediate-early local flap reconstruction: a case report

Yu Ming Lai  1 , Kae-Sian Tay  2 , Shaun Qing Wei Lee  3 , Allen Wei-Jiat Wong  4
Affiliations
Case Reports

Lower limb re-vascularization based on the angiosome concept with immediate-early local flap reconstruction: a case report

Yu Ming Lai et al. J Surg Case Rep. .

Abstract

Lower extremity wounds are a healthcare issue that can result in debilitating consequences. Peripheral arterial occlusive disease (PAOD) being a major contributing factor to the disease, advance revascularization procedures (Angioplasty) based on the angiosome concept has been established in the literature to improve blood supply and promote better healing outcomes. We present a case of a 59-year-old lady with background of hypertension, diabetes and PAOD, was diagnosed with a non-healing foot wound with exposed metal implant. She had targeted angioplasty done based on angiosome concept followed by early local flap reconstruction for coverage, which healed well without complications. Although free tissue transfer has now been the mainstay for lower limb reconstruction with the advancement in microsurgery. Local flaps remain in the armamentarium of lower extremity reconstruction with small to medium sized wound defects. This case demonstrates the advantage of proceeding with immediate-early local flap reconstruction following successful targeted re-vascularization.

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Figures

Figure 1
Figure 1
AP (A) and Lateral (B) X-ray the left foot. Metal implants seen over dorsal MTPJ of the 1st toe after corrective hallux valgus surgery.
Figure 2
Figure 2
(A) 4 × 2cm full thickness wound defect over dorsal MTPJ of left 1st toe with underlying exposed tendon (EHL) and metal implant. (B) Angiosome of the foot—ATA [purple]; medial plantar artery [green]; calcaneal branch of PTA (orange) (C, D) Images showing the incision markings for a medially-based design rotation flap. (E, F) Images showing the final inset of the medially-based rotation flap to the defect site.
Figure 3
Figure 3
Illustrated diagram of left lower limb arterial duplex scan showing 70–80% occlusive disease at the proximal ATA.
Figure 4
Figure 4
Left lower limb diagnostic angiogram showing occlusion of the ATA with poor flow (arrow).
Figure 5
Figure 5
Angiogram of left distal leg and foot showing poor flow of the distal ATA and dorsalis pedis artery (arrow).
Figure 6
Figure 6
Good arterial flow of the ATA (arrow) after successful angioplasty and stenting.
Figure 7
Figure 7
Arterial flow noted at distal ATA and dorsalis pedis artery (arrow) after successful angioplasty and stenting.
Figure 8
Figure 8
Three-month post-operative, flap is fully healed and left foot remains well vascularized with palpable dorsalis pedis pulse.
See this image and copyright information in PMC

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