Salvage of the Hand with a Free Flap in a Hemodialysis Patient with Finger Gangrene and Ipsilateral Arteriovenous Fistula: A Case Report

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.