Evidence of nutritional vascular formation from the “nutrient flap” in a patient with no-option chronic limb-threatening ischemia: An indocyanine green fluorescence imaging study

Abstract

The concept of a “nutrient flap,” in which ischemic tissue is nourished by a transferred well-perfused flap, has been advocated for use since the early days of free flap procedures. Several studies have reported cases of no-option chronic limb-threatening ischemia salvaged by nutrient free flap transfer. However, it has been difficult to prove the actual dynamic flow and nutritional vascular formation. Thus, the existence of a nutrient flap has remained unproved. In the present report, we have described the case of free flap transfer for a patient with no-option chronic limb-threatening ischemia in whom we detected evidence of a nutrient flap using indocyanine green fluorescence imaging.

Keywords

• Chronic limb-threatening ischemia
• Distal bypass
• Distal venous arterialization
• Indocyanine green fluorescence imaging
• Nutrient flap