包括的高度慢性下肢虚血 (CLTI) に対する遊離皮弁移植の経験

抄録

  Chronic limb-threatening ischemia (CLTI) is the most severe form of peripheral artery disease. The WIfI classification system was introduced for CLTI evaluation and treatment. Major amputation is a common treatment for CLTI of the foot with deep wounds and/or severe infection. In the case of ischemic limbs, revascularization (surgical bypass or endovascular treatment) is essential before wound treatment. However, there are a limited number of vascular surgeons capable of performing distal bypass procedures, and most interventional cardiologists in our country are not proactive in revascularizing lower leg arteries. When major amputation is indicated, plastic surgeons have to decide to salvage or amputate the limb depending on the patient’s condition and background. Microsurgical free flap transfer is a viable option in properly selected CLTI patients, and is used as a final option for limb salvage before major amputation. We present our experience with microsurgical reconstruction in CLTI cases. Before microsurgical reconstruction, complete vascular (cardiac and peripheral) workup is needed. The reconstructive microsurgeon must identify recipient arteries and veins, both deep and superficial, around the foot. Furthermore, they should participate in the 1st stage of the debridement operation and check and preserve promising vessels.