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Case Report
Pancreatic acinar cell carcinoma-associated hypercoagulability, combined with diabetic vasculopathy, caused acute limb ischemia and gangrene. A staged multidisciplinary limb-salvage approach achieved wound healing, preserved function, and enabled uninterrupted oncologic therapy, highlighting the importance of integrated, sequential management.
Malignancy-associated hypercoagulability may cause arterial thrombotic events and acute limb ischemia. When combined with diabetic vasculopathy, rapid progression to gangrene and severe infection may occur.
We report a patient with type 2 diabetes who developed acute limb ischemia and progressive diabetic foot gangrene. Despite prior endovascular therapy, severe infection with necrotizing soft tissue infection and osteomyelitis developed. A staged limb-salvage approach involving aggressive debridement, removal of infected bone, pedicled flap reconstruction, antimicrobial therapy, anticoagulation, metabolic optimization, and offloading resulted in successful wound closure and functional recovery. Subsequent investigation revealed pancreatic acinar cell carcinoma, and the patient later received systemic therapy and radiofrequency ablation for liver metastasis.
This case highlights the complex interaction between advanced peripheral arterial disease, severe diabetic foot infection, and pancreatic acinar cell carcinoma (ACC)-associated hypercoagulability. Successful limb salvage was achieved through an integrated multidisciplinary strategy combining vascular intervention, aggressive surgical source control, staged reconstruction, antimicrobial therapy, anticoagulation, metabolic optimization, and oncologic management. Although causality between ACC-associated hypercoagulability and acute limb ischemia cannot be definitively established, this case demonstrates that durable wound healing and functional limb preservation can still be achieved in highly complex patients when treatment is coordinated within a staged, multidisciplinary framework.
Diabetic foot ulcer (DFU) represents a major cause of disability and healthcare burden among individuals with diabetes. Systematic reviews estimate a global prevalence of approximately 6.3%, with a lifetime risk ranging from 19% to 34%, and recurrence after healing occurring frequently1,2,3. From a public health perspective, DFU is associated with repeated hospitalizations, prolonged wound care, and substantial healthcare costs, as well as reduced mobility, impaired quality of life, and increased mortality. Clinically, unfavorable outcomes in DFU are typically driven by the i....
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This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine. Written informed consent was obtained from the patient for participation and publication of clinical data and images. All clinical procedures, including surgical intervention, specimen handling, and imaging acquisition, were performed in accordance with institutional standards and national clinical practice guidelines.
1. Initial clinical assessment
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The patient ultimately achieved successful limb salvage without the need for major amputation (Figure 3). The wound progressively stabilized and reached complete closure. At the latest follow-up, 5 months after the final reconstructive procedure, durable wound healing had been achieved with stable soft-tissue coverage and restoration of the skin barrier (Figure 3). The patient regained independent standing and ambulation without the need for assistive devices. I.......
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DFU represents a major and persistent burden at the population level. A systematic review estimated the global prevalence to be approximately 6.3%1. Other large reviews suggest that the lifetime risk of foot ulceration in patients with diabetes may reach 19–34%, and recurrence after healing is common, often leading to infection, hospitalization, and amputation2,3. These observations underscore that diabetic foot care is not a single .......
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The authors declare that they have no conflicts of interest related to this work.
The authors thank the clinical staff of the Department of Orthopedics and the multidisciplinary team involved in the diagnosis and management of this patient for their support in clinical care and data collection.
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| Name | Company | Catalog Number | Comments |
|---|---|---|---|
| Adobe Illustrator | Adobe Inc. (San Jose, CA, USA) | Illustrator 2024 | Figure preparation |
| Aerobic Culture Medium | BD Diagnostics (Franklin Lakes, NJ, USA) | https://www.bd.com/en-in/products-and-solutions/solutions/capabilities/bd-bactec-blood-culture-media | Bacterial culture |
| Anaerobic Culture Medium | BD Diagnostics (Franklin Lakes, NJ, USA) | https://www.bd.com/en-in/products-and-solutions/solutions/capabilities/bd-bactec-blood-culture-media | Anaerobic bacterial culture |
| Antibiotic-loaded Bone Cement | Heraeus Medical (Wehrheim, Germany) | PALACOS R+G | Temporary local antibiotic delivery |
| BCL-10 Antibody | Abcam (Cambridge, UK) | ab33994 | Immunohistochemical marker for ACC; Dilution as per the manufacturer's guidelines |
| Beraprost Sodium Tablets | Toray Industries (Tokyo, Japan) | Dorner | Peripheral circulation improvement |
| Chromogranin A Antibody | Dako (Glostrup, Denmark) | M0869 | Neuroendocrine marker; Dilution as per the manufacturer's guidelines |
| Formalin Solution (10%) | Sinopharm Chemical Reagent Co., Ltd. (Shanghai, China) | N/A | Tissue fixation |
| Hematoxylin and Eosin Staining Kit | Solarbio (Beijing, China) | G1120 | Histopathological evaluation |
| Ki-67 Antibody | Dako (Glostrup, Denmark) | M7240 | Proliferation index assessment |
| Linezolid Tablets | Pfizer (New York, NY, USA) | Zyvox | Antimicrobial therapy |
| Magnetic Resonance Imaging System | GE Healthcare (Chicago, IL, USA) | Discovery Series | Used for pancreatic imaging |
| Multi-detector CT Scanner | Siemens Healthineers (Erlangen, Germany) | Somatom Series | Used for lower-extremity CTA |
| Nadroparin Calcium Injection | Aspen Pharma (Dublin, Ireland) | Fraxiparine | Anticoagulation |
| Nonionic Iodinated Contrast Agent | Bayer Healthcare (Leverkusen, Germany) | Ultravist 370 | CTA contrast medium |
| Pedicled Fascial Flap Technique | N/A | N/A | Surgical reconstruction technique |
| Piperacillin/Tazobactam | Pfizer (New York, NY, USA) | Zosyn | Antimicrobial therapy |
| Sarpogrelate Hydrochloride Tablets | Mitsubishi Tanabe Pharma (Osaka, Japan) | N/A | Antiplatelet therapy |
| Statistical Analysis Software | IBM Corp. (Armonk, NY, USA) | SPSS Version 26.0 | Data analysis (if applicable) |
| Surgical Drainage Tube | B. Braun (Melsungen, Germany) | https://catalogs.bbraun.com/en-01/c/PRODUCTS/b-braun-standard-product-catalog | Postoperative drainage |
| Synaptophysin Antibody | Dako (Glostrup, Denmark) | M0776 | Neuroendocrine marker; Dilution as per the manufacturer's guidelines |
| Trypsin Antibody | Abcam (Cambridge, UK) | ab200997 | Immunohistochemical marker for ACC; Dilution as per the manufacturer's guidelines |
| VITEK 2 Compact System | bioMérieux (Marcy-l'Étoile, France) | https://www.biomerieux.com/corp/en/our-offer/clinical-products/vitek-2-compact.html | Bacterial identification and susceptibility testing |