Anterolateral Thigh Free Flap to Cover Diabetic Foot Defect by Using Reverse Flow of Severely Calcified Dorsalis Pedis Artery

Abstract

Low blood flow in the distal part of the diabetic foot aggravates the wound to an ischemic state, which eventually leads to amputation. However, major advancements in microvascular surgery have shown the ability to salvage the limb even in the presence of poor perfusion. Since a foot is constituted of a complex network of angiosomes, each separate territory of the foot is supplied by interconnected vessels. We report the successful salvage of a severe diabetic foot injury of a 72-year-old male patient with a heavily calcified dorsalis pedis artery (DPA). Although the proximal end of the DPA was clogged to prevent the flow of blood and was insufficient to use as a recipient vessel, reverse flow from the distal end was restored after removing multiple calcification fragments. As a result, a large soft-tissue defect on the third and fourth toe region was successfully covered by a contralateral anterolateral thigh free flap.