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| Clinical Application of Fogarty Catheter Thrombectomy Combined with Catheter-Based Drug Thrombolysis in Arterial Embolization after Free Flap Surgery in the Foot and Ankle |
| LI Xiaodong, LIU Fei, YAN Xiaowei, et al |
| The Affiliated Hospital of Chengde Medical University, Hebei Chengde 067000, China |
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Abstract Objective: To investigate the efficacy of Fogarty catheter thrombectomy combined with catheter-based drug thrombolysis in the treatment of arterial embolism after free skin flaps in the foot and ankle. Methods: A retrospective analysis was conducted of the clinical data of 16 patients admitted from April 2016 to February 2021 with soft tissue defects in the foot and ankle who underwent free flaps and who had arterial embolism in the flaps after surgery.All patients were treated with Fogarty catheter thrombectomy combined with catheter drug thrombolysis,and the operation time,intraoperative blood loss,arterial patency rate and related complications were recorded.During the follow-up period,the six indexes of the flap combined with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot function score were used to evaluate the curative effect. Results: After surgery,12 flaps were completely viable,2 flaps were partially necrotic,and 2 cases had a recurrence of arterial crisis and were converted to an incisional exploration approach.Excluding 2 patients who were converted to incisional exploration,the 14 patients treated with this procedure had no major bleeding or deaths.The length of the thrombus removed was 0.2~1.8 cm,with an average length of (0.83±0.32) cm.The intraoperative arterial patency rate was 100% and the operative time ranged from 55 to 90 min,with a mean time of (65.12±12.72) min.One case (7.14%) had postoperative gastrointestinal bleeding,which was treated symptomatically.All patients were followed up for 8~21 months,with a median follow-up time of 14.5 (10.4,16.5) months.2 cases (14.3%) were affected by shoe wear,which improved after flap thinning,and 1 case (7.14%) developed a local ulcer,which healed after dressing change.At the last follow-up,the flap had a good texture and sensation was restored to S2 to S3 level,with protective sensation restored in all cases and only one point of discrimination in both cases.Foot and ankle function improved with an AOFAS ankle-hindfoot function score of 59 to 95,mean (83.72±6.42),with an excellent AOFAS ankle-hindfoot function rate of 71.42%. Conclusion: Fogarty catheter thrombectomy combined with drug thrombolysis in the treatment of arterial embolism after free skin flap in the foot and ankle is minimally invasive,fast,safe,and has definite clinical efficacy.
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2022, Vol. 28 
