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Reclaiming Autologous Amputated Tissue for Limb Salvage of a Diabetic Foot Burn with Underlying Critical Limb Ischemia

Tchanque-Fossuo, Catherine, N., MD, MS; Wishy, Andrew, M., DO; West, Kaitlyn I., M.; Dawson, David, L., MD; Dahle, Sara, E., DPM, MPH; Carson, John, G., MD

doi: 10.1097/01.ASW.0000526604.26748.3d
Features: Case Report

BACKGROUND: Diabetes mellitus is a worldwide pandemic that impacts more than 387 million people, with 29 million individuals affected in the United States alone. Diabetic patients have a 25% lifetime risk of developing a diabetic foot ulcer (DFU). Having a DFU is associated with a risk of recurrence approaching 70%. In addition, 1 in 6 patients with DFU will have a lower-limb amputation, with an associated increase in mortality ranging from 47% to 70%. Therefore, limb salvage is critical in patients with DFU.

CASE STUDY: This article describes the case of a 70-year-old man with diabetes mellitus, end-stage renal disease, and peripheral arterial occlusive disease who presented with a 1.5% total-body-surface-area, third-degree burn to the left hallux with dry gangrene extending to the midfoot. Ankle brachial indexes were 0.66 on the left and 0.64 on the right. Toe pressures on the left were absent because of extensive dry gangrene. His right foot had a prior transmetatarsal amputation. Using a retrograde pedal approach, a chronic total occlusion of the left posterior tibial artery was recanalized with balloon angioplasty. He then underwent a transmetatarsal amputation with closure, except that the plantar medial side could not be closed without tension. Therefore, an autologous full-thickness skin graft, from the amputation specimen, was used to bridge the defect.

DISCUSSION: At 32-week follow-up, the wound was healed, the graft had fully incorporated, and the patient was ambulating well using custom orthotic footwear. The creative use of amputated tissue to assist with wound coverage has not been well described in the literature.

Catherine N. Tchanque-Fossuo, MD, MS, is a Postdoctoral Clinical Wound Fellow, Department of Dermatology, University of California Davis, Sacramento, California. Andrew M. Wishy, DO, is a Vascular Surgery Resident, Division of Vascular and Endovascular Surgery, University of California Davis, Sacramento, California. Kaitlyn I. M. West is a Student, University of California Davis, Sacramento, California. David L. Dawson, MD, is Professor and Program Director, Division of Vascular and Endovascular Surgery, University of California Davis, Sacramento, California. Sara E. Dahle, DPM, MPH, is Chief of Podiatry, Department of Surgery, Sacramento VA Medical Center, Mather, California, and Assistant Professor, Department of Dermatology, University of California Davis, Sacramento, California. John G. Carson, MD, is Chief of Vascular Surgery, Department of Surgery, Sacramento VA Medical Center, Mather, California, and Assistant Professor, Division of Vascular and Endovascular Surgery, University of California Davis, Sacramento, California.

The authors have disclosed that they have no financial relationships related to this article.

Submitted April 3, 2016; accepted in revised form September 7, 2016.

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