A Case of Hemodialysis Patient Treated with a Latissimus Dorsi Myocutaneous Flap for an Intractable Ulcer of the Knee

Abstract

A 59 year old man with long term hemodialysis suffered from left critical limb ischemia. The limb was preserved by revascularization using a bypass graft. One year after limb rescue, skin ulcer occurred on the left knee and progressed to suppurative arthritis of the knee. This knee was treated with arthrodesis. The soft tissue did not heal by skin closure following debridement of the ulcer. A free latissimus dorsi musculocutaneous flap was performed. As the recipient artery, we selected the former femoral artery that had been obstructed at the popliteal region for protection of the bypass graft. This elaboration of the anastomosis technique allowed the flap to survive. Microsurgical reconstruction of soft tissue is important even in chronic dialysis patients to avoid the need for amputation.