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Lower Extremity Salvage with Thoracodorsal Artery Perforator Free Flap in Condition of Symmetrical Peripheral Gangrene.

Title
Lower Extremity Salvage with Thoracodorsal Artery Perforator Free Flap in Condition of Symmetrical Peripheral Gangrene.
Author
성일훈
Keywords
DISSEMINATED INTRAVASCULAR COAGULATION; VASOPRESSIN INFUSION; PURPURA FULMINANS; SKIN NECROSIS; SEPTIC SHOCK; AMPUTATION; TRANSMETATARSAL; RECONSTRUCTION; NORADRENALINE; LIMBS
Issue Date
2018-05
Publisher
HINDAWI LTD
Citation
BIOMED RESEARCH INTERNATIONAL, Article no. 6508607
Abstract
Symmetrical peripheral gangrene (SPG) is rare but devastating complication which is characterized by symmetrical ischemic change of the distal extremities. In this report, we describe our management protocol for SPG, focusing on surgical approaches. Between January 2007 and February 2016, 10 thoracodorsal artery perforator (TDAP) free flaps were performed in 6 patients with SPG. Three patients were male and mean age was 56 (range, 44-69) years. All the patients were in shock. The causes of shock were sepsis in 4 cases, respiratory arrest in 1 case, and hypovolemia in 1 case. Eight transmetatarsal amputations and 2 Lisfranc amputations were performed. Flap sizes ranged from 7 x 11 cm to 25 x 15 cm. There were 3 cases of partial necrosis of the flap: two healed conservatively with dressings and one required skin graft. Three of the patients were later able to walk independently at Functional Ambulation Classification (FAC) level 6, one patient could walk independently on level surfaces at FAC level 5, and 2 could walk independently using walking aids, classified at FAC level 4. The average follow-up period was 18 (range, 6-54) months. In patients with SPG, minimal bone amputation and foot salvage with TDAP flaps were successful. Separate reconstruction of bone and soft tissue had good outcomes.
URI
https://www.hindawi.com/journals/bmri/2018/6508607/http://repository.hanyang.ac.kr/handle/20.500.11754/118761
ISSN
2314-6133; 2314-6141
DOI
10.1155/2018/6508607
Appears in Collections:
COLLEGE OF MEDICINE[S](의과대학) > MEDICINE(의학과) > Articles
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