Objective: Describe the clinical courses of and reconstructive methods utilized for two patients with diabetes who presented with gangrenous feet following Covid-and required partial foot amputations.

Background: Covid-produces mainly respiratory symptoms but has a variety of atypical presentations and sequelae. Serious complications are increased in patients with underlying medical conditions such as diabetes mellitus. By generating a prothrombotic milieu, SARS-CoV-2 increases the risk for arterial and venous thromboses. Inflammatory damage and micro-thromboses are thought to contribute to acro-ischemia, colloquially known as “Covid Toes,” which presents cutaneously as chilblain-like lesions.

Case Report: (1) A 57 year old female presented to vascular clinic with pedal gangrene one month after developing painful discoloration in her right toes. After angioplasty restored pedal blood flow, she received a TMA with a local fillet flap. (2) A 41 year old female presented to vascular clinic with extensive pedal gangrene three months after hospitalization for Covid-19. After arteriotomy improved pedal blood flow, she underwent a Lisfranc amputation followed by SCIP flap reconstruction.

Conclusion: Sufficient evidence suggests that Covid-impairs microcirculatory function and can be especially detrimental in diabetic patients. Reconstructive techniques in patients with severe Covid Toes help patients regain functionality.


M.Swerdlow: None. G.T.Kress: None. L.Shin: None.

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