Abstract
A 50-year-old man with type 2 diabetes mellitus and hypertension had been undergoing hemodialysis from the age of 41 due to diabetic renal failure. He also suffered from peripheral arterial disease, which was managed by endovascular therapy in an internal medicine department. One year before his first visit to our department, an ulcer had appeared on the middle toe of his right foot. Regardless of other endovascular therapy, the ulcer expanded and he consulted our department, but infection of the ulcer worsened his general condition. Modified transmetatarsal amputation of his right foot and a superficial femoral-dorsal pedis artery bypass were performed, but the ulcer expanded to the heel. Topical, less invasive treatment seemed hopeless, and the ulcer was treated with a rectus abdominis muscle flap and free skin graft to enable the patient to walk by himself. Six months later, an ulcer on the middle toe of his left foot following a small injury developed and rapidly enlarged, but was finally improved by Lisfranc's joint disarticulation leaving the left heel. In such cases, limb revascularization may take a long time, but it enables us to salvage critical limb ischemia.Skin Research, 12: 18-25, 2013
