Thromboangiitis obliterans, or Buerger disease, is a rare nonatherosclerotic segmental inflammatory vasculitis that generally affects young tobacco smokers. Although no surgical treatment is available, the most effective way to halt the disease's progress is smoking cessation. In this case report, a 29-year-old smoker showed up to emergency department with gangrene of his fifth left toe and extensive plantar ulceration. After investigative angiography, he was diagnosed with Buerger disease. On November 2017, he underwent fifth left toe amputation and hyperbaric therapy. Five months after amputation, the patient was rehospitalized because of surgical wound dehiscence, wide ulceration, and pain. He was treated with lipofilling using the Coleman technique. Two weeks after the fat grafting procedure, the patient suspended pain control medication, and after 2 months, the surgical wound was almost healed. Fat grafting (lipofilling) is mostly used in plastic surgery; it offers regenerative effects, with minimal discomfort for the patient. This case report demonstrates a successful alternative use of lipofilling for this unique condition and opens up new options for use of this technique in other fields.
In Milan, Italy, Ilenia D’Alessio, MD, is a trainee, Department of Vascular Surgery, Fondazione IRCCS Policlinico; Alberto M. Settembrini, MD, is a surgeon, Department of Vascular Surgery, Fondazione IRCCS Policlinico; Silvia Romagnoli, MD, is a surgeon, Department of Vascular Surgery, Fondazione IRCCS Policlinico; Gabriele Di Luca, MD, is a surgeon, Section of Vascular Surgery, ASST Gaetano Pini; Maurizio Domanin, MD, is a surgeon, Department of Vascular Surgery, Fondazione IRCCS Policlinico; and Livio Gabrielli, MD, is a professor of vascular surgery, University of Milan. The authors have disclosed no financial relationships related to this article. Submitted April 10, 2019; accepted in revised form July 9, 2019.