Complex Lower Extremity Salvage Using Composite Flap Grafting in COVID-19-Induced Arterial Thrombosis: A Case Report.

Q4 Medicine JBJS case connector Pub Date : 2025-01-30 eCollection Date: 2025-01-01 DOI:10.2106/JBJS.CC.24.00427
Neil Jain, Caroline J Cushman, Evan J Hernandez, Nicholas T Haddock, Brendan J MacKay
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Abstract

Case: We present a 42-year-old man who developed extensive left lower extremity arterial thrombosis following COVID-19 pneumonia. Despite multiple revascularization attempts and a below-knee amputation, he faced wound necrosis and insufficient soft tissue coverage. An innovative approach using a pedicled flap and sequential flow-through free flaps was used for limb salvage. Further interventions included through-knee amputation and targeted muscle reinnervation vs. nerve capping to address phantom limb pain.

Conclusion: This case demonstrates the potential of sequential flow-through free flaps in complex limb salvage when traditional revascularization is unfeasible, emphasizing early intervention and vigilant complication management.

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复合皮瓣移植治疗新冠肺炎动脉血栓形成复合下肢抢救1例
病例:我们报告了一名42岁的男性,他在COVID-19肺炎后出现了广泛的左下肢动脉血栓形成。尽管多次尝试血运重建和膝盖以下截肢,他仍然面临伤口坏死和软组织覆盖不足的问题。一种采用带蒂皮瓣和连续流动自由皮瓣的创新方法用于肢体保留。进一步的干预包括通过膝关节截肢和靶向肌肉再神经支配与神经封顶来解决幻肢痛。结论:本病例显示了序贯游离皮瓣在传统血运重建不可行的复杂肢体抢救中的潜力,强调早期干预和警惕并发症的处理。
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来源期刊
JBJS case connector
JBJS case connector Medicine-Medicine (all)
CiteScore
0.60
自引率
0.00%
发文量
319
期刊介绍: JBJS Case Connector helps improve patient care by providing the medical community with a journal that harnesses technology to provide information tools for discovery and reporting of unusual musculoskeletal problems, findings, treatment, and outcomes. Co-edited by Thomas W. Bauer, MD, PhD, and Ronald W. Lindsey, MD, JBJS Case Connector assists orthopaedic surgeons in the search for precedents, connections, and trends in their efforts to improve patient care. Using this unique journal, surgeons can find the commonalities between cases, benefit from the experience of their peers, and filter case information by many important variables in order to provide the best possible care for orthopaedic patients. This cross-referenced online journal includes thousands of orthopaedic case reports. It compiles symptoms, conditions, and demographic details to empower surgeons to find cases similar to theirs. Surgeons can mine the database to reveal emerging trends and identify patterns, distinguishing between truly rare cases and repeated, related single instances of a larger problem. The JBJS Case Connector Image Quiz feature provides interactive quizzes based on images from content published by JBJS and includes a discussion area for further exploration of ideas and concepts. The JBJS Image Quiz app for iPad and iPhone is available in the App Store. Contributions to JBJS Case Connector are welcomed from anywhere in the world and are considered on their merits. Articles must be written in English and should be submitted as outlined in the Instructions to Authors. All authors must abide by the JBJS ethics policies and all submissions to JBJS Case Connector are covered by the JBJS embargo policy.
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