重症下肢虚血 (Critical Limb Ischemia: CLI) 治療に対するマイクロサージャリーの注意点と工夫

抄録

　Microsurgical techniques are employed in the treatment of critical limb ischemia (CLI) for free-flap reconstruction of tissue defects in the foot and microsurgical distal bypass for ischemia. CLI is accompanied by arteriosclerosis and calcification of the vessel wall in almost all cases. In our department, we have performed free-flap reconstruction and microsurgical distal bypass surgery for CLI cases. It is important to confirm the presence or absence of calcified lesions before surgery and to determine the anastomosis site in advance. CT and ultrasound are useful for determining the anastomosis site. Because partial necrosis of the skin flap is likely to occur if the blood flow in the lower limbs is low, revascularization using endovascular treatment is necessary before surgery. Marginal necrosis may occur even when the flap size is large. Herein, we explain the precautions and considerations when performing microsurgery for CLI, based on our experience in our department.