Microvascular Distal Foot Arterialization With Flow-Through Free Flaps for Salvage of the No-Option Foot

Document Type

Conference Proceeding

Publication Date

9-2026

Publication Title

Plastic and Reconstructive Surgery. Global Open

Abstract

Objective: Patients with chronic limb-threatening ischemia (CLTI) and no distal arterial targets represent a “no-option” cohort with high rates of major amputation. Deep vein arterialization (DVA) provides an alternative but is limited by inconsistent healing and complications such as chronic edema. We describe a novel technique combining flowthrough free flap reconstruction with microvascular distal foot venous arterialization to achieve limb salvage in this population. Methods: A retrospective case series of three patients with CLTI and complex foot wounds requiring soft tissue reconstruction without feasible conventional revascularization was performed. All patients had preserved ankle-level inflow and an intact dorsal venous arch. Flow-through or branch-based free flaps were used to provide both wound coverage and arterial inflow. Select dorsal foot veins were divided, valve-disrupted, and anastomosed to the flap arterial system to achieve targeted arterialization of the forefoot. Outcomes included flap survival, wound healing, limb salvage, and ambulatory status. Results: All three patients underwent successful reconstruction with 100% flap survival. Complete wound healing was achieved in all cases. Two patients demonstrated durable perfusion and remained fully ambulatory at long-term follow-up of 3 and 6 years, respectively. One patient required transmetatarsal amputation at 14 months due to recurrent distal ischemia but maintained limb salvage and ambulatory function at 4 years. Postoperative Doppler examination confirmed sustained arterialized flow throughout the dorsal forefoot in all patients. No cases of chronic venous hypertension or limb edema were observed. Conclusion: Microvascular distal foot arterialization using flow-through free flaps represents a promising limb salvage strategy for patients with no-option CLTI. This approach simultaneously addresses soft tissue defects and restores distal perfusion through selective venous arterialization while avoiding complications associated with traditional DVA. Early outcomes demonstrate durable perfusion, high rates of wound healing, and preservation of ambulation. Further study is warranted to define patient selection criteria and long-term efficacy.

Volume

14

Issue

S4

First Page

16

Last Page

17

Comments

Michigan Academy of Plastic Surgeons Annual Meeting, July 12-15, 2026, Mackinac Island, MI

DOI

10.1097/01.GOX.0001276756.19455.6e

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