Complex staged reconstruction and limb salvage in a patient with traumatic arteriovenous fistula and non-healing wounds of the calf
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 l...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-12-01
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| Series: | Annals of Vascular Surgery - Brief Reports and Innovations |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772687821000179 |
| _version_ | 1797788363127783424 |
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| author | Sujin Lee Branko Bojovic Anahita Dua |
| author_facet | Sujin Lee Branko Bojovic Anahita Dua |
| author_sort | Sujin Lee |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-13T01:34:31Z |
| format | Article |
| id | doaj.art-006d4952af5f49298997d02e0cd9642d |
| institution | Directory Open Access Journal |
| issn | 2772-6878 |
| language | English |
| last_indexed | 2024-03-13T01:34:31Z |
| publishDate | 2021-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Vascular Surgery - Brief Reports and Innovations |
| spelling | doaj.art-006d4952af5f49298997d02e0cd9642d2023-07-04T05:11:33ZengElsevierAnnals of Vascular Surgery - Brief Reports and Innovations2772-68782021-12-0112100016Complex staged reconstruction and limb salvage in a patient with traumatic arteriovenous fistula and non-healing wounds of the calfSujin Lee0Branko Bojovic1Anahita Dua2Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Massachusetts General Hospital, 139 Charles Street, 1A, 55 Fruit St, 02114, Boston, MA 02117, United States; Corresponding author.Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, United StatesDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, Massachusetts General Hospital, 139 Charles Street, 1A, 55 Fruit St, 02114, Boston, MA 02117, United StatesArteriovenous 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.http://www.sciencedirect.com/science/article/pii/S2772687821000179 |
| spellingShingle | Sujin Lee Branko Bojovic Anahita Dua Complex staged reconstruction and limb salvage in a patient with traumatic arteriovenous fistula and non-healing wounds of the calf Annals of Vascular Surgery - Brief Reports and Innovations |
| title | Complex staged reconstruction and limb salvage in a patient with traumatic arteriovenous fistula and non-healing wounds of the calf |
| title_full | Complex staged reconstruction and limb salvage in a patient with traumatic arteriovenous fistula and non-healing wounds of the calf |
| title_fullStr | Complex staged reconstruction and limb salvage in a patient with traumatic arteriovenous fistula and non-healing wounds of the calf |
| title_full_unstemmed | Complex staged reconstruction and limb salvage in a patient with traumatic arteriovenous fistula and non-healing wounds of the calf |
| title_short | Complex staged reconstruction and limb salvage in a patient with traumatic arteriovenous fistula and non-healing wounds of the calf |
| title_sort | complex staged reconstruction and limb salvage in a patient with traumatic arteriovenous fistula and non healing wounds of the calf |
| url | http://www.sciencedirect.com/science/article/pii/S2772687821000179 |
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