Limb Salvage in Acute Limb Ischemia and Diabetic Foot Gangrene Associated with Pancreatic Acinar Cell Carcinoma-Related Hypercoagulability.

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.