Annals of Vascular Surgery - Brief Reports and Innovations (Dec 2023)
Evaluation of the efficacy of Fogarty catheter embolectomy combined with drug thrombolysis for the treatment of arterial embolization after free flap transplantation of the foot and ankle
Abstract
Objective: Repair of free skin flaps to soft tissue defects is common in the clinic. Arterial crisis is a common complication after free flap surgery. This study aimed to investigate the effect of Fogarty catheter embolectomy combined with catheter-based drug thrombolysis to treat arterial embolism after free flap operation. Methods: Eight patients with soft tissue defects in foot and ankle repair with a free flap were analyzed. All patients received Fogarty catheter embolectomy combining catheter-based drug thrombolysis. Operation time, intraoperative blood loss, arterial patency rate, and complications were recorded. Flap survival was observed, and the curative effect was evaluated by the American orthopedic foot ankle society (AOFAS) score. Results: Among eight patients, six flaps completely survived (primary (I) incision healing), one case had partial flap necrosis (secondary (II) incision healing), and one case developed threatened arterial supply again (secondary (II) healing). The causes of defects included crushing injury (three cases), crush injury (two cases), explosive injury (one case), burn injury (one case), and cutting injury (one case). Excluding one patient who changed to incision and exploration, the artery patency rate in eight patients was 87.5 % (7/8), with an average operation time of 65 min (55–90 min) and an average intraoperative blood loss of 65 ml (35–70 ml). At the last follow-up, the flap survived well, foot and ankle function improved, the satisfactory flap rate was 85.71 % and the excellent/good AOFAS ankle hindfoot function rate was 71.42 %. For the typical patient, after 1.5 years of follow-up, the curative effect of the flap was satisfactory and the AOFAS score was 92, demonstrating excellent ankle function. Conclusions: Fogarty catheter embolectomy combined with catheter-based thrombolysis is minimally invasive, fast, safe, and effective for the treatment of arterial embolism after free flap foot and ankle transplantation.
