Abstract
A 76-year-old man complained of frequent bleeding from the left IV toe and was diagnosed with a traumatic arteriovenous malformation based on examination findings and a history of bruising in the same area. Surgical ligation of the dorsal ankle, dorsal foot, and posterior tibial arteries at the level of the ankle joint was performed by a surgeon at the previous hospital. However, the lesion worsened, so the patient was referred to the radiology department and underwent four percutaneous sclerotherapy treatments. Thereafter, the pain improved, but erythema, pus drainage, and necrosis of the skin of the left third and fourth toes were observed. The patient was referred to our hospital for sclerotherapy and toe amputation. After amputation, negative-pressure wound therapy was performed, and the patient healed with split-thickness skin grafting. In this case, a patient with an arteriovenous malformation of the foot underwent ligation of a nutrient artery at another hospital, which resulted in worsening of the lesion and necrosis of the toe. It was considered difficult to preserve the affected limb beyond the ankle joint. However, we performed toe dissection combined with sclerotherapy at our hospital and successfully preserved the affected limb.
(A) First visit to our hospital (B) Operation photo of amputation, design of dermal incision line (C) Split thickness-skin graft was harvested on 15 days after amputation. (D) Wound epithelialization was obtained at 5 month after skin graft.
