Definitive coverage of distal vein graft in a case of early skin necrosis following popliteal to dorsalis pedis bypass

Sam Taylor; Sinead Gormley; Maria Mani; Kevin Mani; Manar Khashram

doi:10.1016/j.jvscit.2023.101233

Definitive coverage of distal vein graft in a case of early skin necrosis following popliteal to dorsalis pedis bypass

J Vasc Surg Cases Innov Tech. 2023 May 25;9(4):101233. doi: 10.1016/j.jvscit.2023.101233. eCollection 2023 Dec.

Authors

Sam Taylor¹, Sinead Gormley^{1

2}, Maria Mani³, Kevin Mani⁴, Manar Khashram^{1

2}

Affiliations

¹ Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand.
² Department of Surgery, The University of Auckland, Auckland, New Zealand.
³ Section of Plastic Surgery, Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden.
⁴ Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.

Abstract

Inframalleolar bypass is an effective intervention for chronic limb threatening ischemia. A successful outcome can be compromised by early pedal wound disruption with secondary bypass exposure. We describe the case of a 74-year-old man with a WIfI (wound, ischemia, foot infection) clinical stage 4 foot who underwent popliteal-dorsalis pedis bypass, complicated by early skin necrosis overlying the pedal anastomosis. This necessitated a multidisciplinary approach to obtain tissue coverage over the anastomosis. The wound healed within 28 days, and at 2 years, the patient was mobilizing independently. We outline the approach taken and discuss the management of this challenging limb salvage problem.

Keywords: Bypass; Chronic limb-threatening; Diabetic foot; Ischemia; Wound infection.

Publication types

Case Reports