Complex staged reconstruction and limb salvage in a patient with traumatic arteriovenous fistula and non-healing wounds of the calf

Abstract

Arteriovenous fistulas (AVFs) are vascular anomalies that may result in uncontrollable hemorrhage and non-healing wounds that are challenging to manage and require complex surgical reconstruction with thoughtful reconstructive strategies. In this case report, we present a patient with a threatened limb from a traumatic AVF and chronically infected hematoma. He required complex staged endovascular and open reconstruction followed by negative pressure wound therapy (NPWT) for optimal wound healing with excellent results. Polyvinyl alcohol particles were used as selective pre-operative embolic agents to achieve tissue ischemia prior to hematoma excision and reconstruction with pedicled nerve transfer to decrease neuroma formation. NPWT with instillation of Dakin's solution and dwell time was used to reduce the dead space while promoting the formation of granulation tissue and treating the infection by reducing the bioburden. After 1 week of NPWT, there was excellent granulation tissue with retraction of the wound allowing for split thickness skin grafting. The graft healed completely and allowed him to return to his baseline function and resume his dancing career at 1 year follow-up.