Reconstruction for Severe Extracorporeal Membrane Oxygenation-induced Ischemic Lower Limb Injury Complicated by Osteomyelitis

Takeaki Hidaka, MD; Masakazu Kurita, MD, PhD; Shimpei Miyamoto, MD, PhD; Mika Watanabe, MD; Yutaro Kitamura, MD; Keita Okada, MD, PhD; Sayaka Fujiwara, MD, PhD; Mutsumi Okazaki, MD, PhD

doi:10.1097/GOX.0000000000003074

Plastic and Reconstructive Surgery, Global Open (Aug 2020)

Reconstruction for Severe Extracorporeal Membrane Oxygenation-induced Ischemic Lower Limb Injury Complicated by Osteomyelitis

Takeaki Hidaka, MD,
Masakazu Kurita, MD, PhD,
Shimpei Miyamoto, MD, PhD,
Mika Watanabe, MD,
Yutaro Kitamura, MD,
Keita Okada, MD, PhD,
Sayaka Fujiwara, MD, PhD,
Mutsumi Okazaki, MD, PhD

Affiliations

Takeaki Hidaka, MD: From the * Department of Plastic, Reconstructive and Aesthetic Surgery, The University of Tokyo Hospital, Tokyo, Japan
Masakazu Kurita, MD, PhD: From the * Department of Plastic, Reconstructive and Aesthetic Surgery, The University of Tokyo Hospital, Tokyo, Japan
Shimpei Miyamoto, MD, PhD: From the * Department of Plastic, Reconstructive and Aesthetic Surgery, The University of Tokyo Hospital, Tokyo, Japan
Mika Watanabe, MD: From the * Department of Plastic, Reconstructive and Aesthetic Surgery, The University of Tokyo Hospital, Tokyo, Japan
Yutaro Kitamura, MD: From the * Department of Plastic, Reconstructive and Aesthetic Surgery, The University of Tokyo Hospital, Tokyo, Japan
Keita Okada, MD, PhD: † Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo Hospital, Tokyo, Japan
Sayaka Fujiwara, MD, PhD: ‡ Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Mutsumi Okazaki, MD, PhD: From the * Department of Plastic, Reconstructive and Aesthetic Surgery, The University of Tokyo Hospital, Tokyo, Japan

DOI: https://doi.org/10.1097/GOX.0000000000003074
Journal volume & issue: Vol. 8, no. 8
p. e3074

Abstract

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Summary: Extracorporeal membrane oxygenation (ECMO) is a well-established mechanical circulatory support system used in patients with life-threatening cardiopulmonary conditions. However, severe complications associated with vascular access require consideration. We report a patient with fatal ventricular arrhythmia who was successfully resuscitated with ECMO but who developed severe lower limb ischemia, which resulted in compartment syndrome. Even with emergent fasciotomy, tissue necrosis developed in wide areas of the limb, with subsequent tibial osteomyelitis. After extensive debridement and tibial sequestrectomy, the soft tissue and bone defect were simultaneously reconstructed with free tissue transfer of the latissimus dorsi muscle and scapular tip composite flap. The limb was successfully salvaged with satisfactory functional outcomes without major complications. This report discusses limb reconstruction for ECMO-induced compartment syndrome and illustrates the importance of appropriate selection of reconstruction methods among various composite flaps.

Published in Plastic and Reconstructive Surgery, Global Open

ISSN: 2169-7574 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://www.prsgo.com

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