Work

Staged matrix and micrografting reconstruction for no-option CLTI: A case report

Year: 2026

Type: article

Abstract: Venous arterialization has emerged as a limb-salvage option for selected patients with no-option chronic limb-threatening ischemia, particularly those with type 2 diabetes, extensive pedal occlusive disease, and small artery disease (distal tibial and inframalleolar disease) in whom conventional bypass or endovascular revascularization is not an option. We present a case of a man in his late 70s with diabetes and severe distal occlusive disease who underwent endovascular venous arterialization for a threatened limb with gangrene, followed by staged wound reconstruction after open transmetatarsal amputation. Reconstruction was performed in a stepwise manner with serial debridement and wound-bed preparation, application of an Integra dermal regeneration template to augment granulation tissue formation, and subsequent Meek fractional skin grafting for definitive coverage. The wound healed over approximately 7 months, and the patient regained the ability to ambulate. This case highlights the concept that venous arterialization should be viewed not as an isolated revascularization maneuver, but as the perfusion-enabling stage of a broader reconstructive pathway in no-option limb salvage.

Source: Science Progress

DOI: 10.1177/00368504261477986

Authors: Dimitrios Miserlis, Lucas Ferrer, Reza M. Mizani, Mark G. Davies, Panagiotis Koutakis

Institutions: The University of Texas at San Antonio, Ascension, University of Nebraska Medical Center

Language: English

Topic: Peripheral Artery Disease Management

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,650