Femoro-popliteal Artery Bypass and Transmetatarsal Amputation Followed by Delayed Forefoot Flap

Abstract

Critical limb ischemia (CLI) is a severe blockage in the arteries of the lower extremities, which markedly reduces blood-flow. It is a serious form of peripheral arterial disease, or PAD, but less common than claudication. PAD is caused by atherosclerosis, the hardening and narrowing of the arteries over time due to the buildup of fatty deposits called plaque. CLI is a chronic condition that results in severe pain in the feet or toes, even while resting. Complications of poor circulation can include sores and wounds that won't heal in the legs and feet. Left untreated, the complications of CLI will result in amputation of the affected limb. The authors present a patient with CLI, and a left forefoot gangrene treated with multi-stage operations (femoro-popliteal arterial bypass, transmetatarsal amputation and delayed forefoot free-flap) with good results.