(PC062) Microvascular Distal Foot Arterialization with Flow Through Free Flaps For Salvage of the No-Option Foot

Objectives: Patients with chronic limb threatening ischemia (CLTI) and complex foot wounds may face a lack of traditional salvage options when the pedal vasculature is severely compromised, rendering arterial revascularization of the foot itself impossible. Here we introduce a novel technique, microvascular distal foot arterialization with flow-through free flaps, to overcome these challenges and provide durable salvage to the no-option foot.

Methods: Three patients with diabetes and CLTI presented with gangrenous forefoot and midfoot wounds that were ischemic despite maximal attempts at arterial revascularization. Each patient had severe pedal arterial disease and osteomyelitis. Wound reconstruction was performed in each case using free flaps anastomosed to pulsatile vessels at the ankle. The flaps also each included a flow through vessel which was used to arterialize the distal dorsal venous network of the foot, thus achieving immediate wound closure and treatment of ischemia.

Results: There were no flap losses. All three patients achieved complete wound healing and returned to ambulation. Vascular examination at follow-up demonstrated convincingly that venous arterialization remained patent and had durably revascularized the foot. No patients suffered from edema or venous engorgement. Limb salvage and perfusion were maintained for each patient at 6, 4, and 2.5 years of followup, respectively. Further details are presented in accompanying videos.

Conclusions: Microvascular distal foot arterialization is a novel, powerful technique that allows durable salvage in cases that would otherwise require amputation due to severe wounds combined with unreconstructable ischemia. In contrast to deep venous arterialization, no complications of the technique were noted. Our intention with this presentation is to stimulate further investigation into this technique by other surgeons.