Abstract
In critical limb ischemia (CLI) of a maintenance hemodialysis patient, leg amputation of the foot region, lower leg, or thigh not only severely debilitates the patient, but is also known to have a serious negative effect on the prognosis. For these reasons, a major challenge when administering treatment of CLI is to avoid leg amputation and preserve the walking function to the greatest extent possible. Here, we describe the use of a latissimus dorsi myocutaneous flap together with a vein bypass graft to treat an intractable heel ulcer arising from a tissue deficit in a maintenance hemodialysis patient, thereby providing comfort to the leg region. The case was a 49-year-old male patient who came to this hospital in April 2010 for hemodialysis due to chronic kidney failure brought on by diabetic kidney disease. Pain and skin ulcer occurred in the patient's right heel from around May 2011. The patient was hospitalized after signs of infection were found in the same region. Antibiotics were administered and debridement was conducted for the infected region, but there was no improvement. The skin ulcer further aggravated, leading to a tissue deficit. Therefore, in August 2011, we used a latissimus dorsi myocutaneous flap together with a vein bypass graft, which enabled us to reduce the pain in the patient's leg and preserve the walking function. This suggested that the combined use of a vein bypass graft and free flap can be an effective CLI treatment option for hemodialysis patients.
