Abstract

DAGNINO URRUTIA, Bruno; MARINE MASSA, Leopoldo; SALISBURY DEVINCENZI, Carolina  and  CIFUENTES ORTIZ, Ignacio. Combined lower limb reconstruction with free tissue transfer anastomosed to a vascular bypass. Case report. Cir. plást. iberolatinoam. [online]. 2020, vol.46, n.2, pp.207-210.  Epub Aug 17, 2020. ISSN 1989-2055.  https://dx.doi.org/10.4321/s0376-78922020000300010.

We present a case of lower extremity reconstruction combining bypass revascularization and free flap for soft tissue coverage in a 72-year-old diabetic man with lower extremity arterial occlusive disease and wide soft tissue defect with bone exposure, who was treated with a popliteal-pedal vein saphenous bypass and a free rectus abdominis muscle flap.

The bypass was used as the arterial inflow to the flap and an interposition saphenous vein graft to the popliteal vein as the outflow vessel, due the absence of appropriate local venous receptor vessels.

In patients with concomitant occlusive arterial disease, combined treatment with surgical revascularization and free flap coverage is associated with a high rate of limb salvage and excellent functional outcomes. The free rectus abdominis flap provides adequate coverage and filling of the defect, as well as advantages in terms of dissection time and donor vessel diameter. In cases of inadequate recipient vessels, it is possible to use the bypass conduit as an arterial inflow and another venous graft for outflow to a proximal vessel.

Keywords : Free tissue transfer; Lower extremity; Lower extremity reconstruction; Lower extremity ischemia.

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