Hsieh CH, Tsai HH, Yin JW, Lin TS, Jeng SF. Salvage of the Hand with a Free Flap in a Hemodialysis Patient with Finger Gangrene and Ipsilateral Arteriovenous Fistula: A Case Report.
Ann Vasc Surg 2004;
18:365-8. [PMID:
15354642 DOI:
10.1007/s10016-004-0023-8]
[Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We describe the case of a female with end-stage renal disease who developed a left ischemic hand and index finger gangrene 2 years after commencement of hemodialysis. Ray amputation was performed, however, the surgical wound was complicated by progressive soft tissue necrosis and metacarpal bones exposure. To avoid amputation at a higher level, we repaired the defect successfully with a free anterolateral thigh perforator flap. A radiocephalic arteriovenous fistula, the dialysis access, was divided to provide the recipient vessels. Reconstruction with this method has the advantage of a staged arteriovenous fistula, which can increase the free-flap success rate, and has the potential to improve perfusion of the distal ischemic hand.
Collapse