Oh TS, Lee HS, Hong JP, et al.
Journal of plastic, reconstructive & aesthetic surgery : JPRAS. Date of publication 2013 Feb 1;volume 66(2):243-50.
1. J Plast Reconstr Aesthet Surg. 2013 Feb;66(2):243-50. doi:
10.1016/j.bjps.2012.09.024. Epub 2012 Oct 24.
Diabetic foot reconstruction using free flaps increases 5-year-survival rate.
Oh TS(1), Lee HS, Hong JP.
Author information:
(1)Department of Plastic Surgery, Asan Medical Center, University of Ulsan
College of Medicine, Songpa-gu, Poongnap2-dong, 388-1, Seoul 138-736, South
Korea.
The purpose of this study was to evaluate the outcome of the diabetic foot
reconstructed with free flaps and analyse the preoperative risk factors. This
study reviews 121 cases of reconstructed diabetic foot in 113 patients over 9
years (average follow-up of 53.2 months). Patients' age ranged from 26 to 78
years (average, 54.6 years). Free flaps used were anterolateral thigh (ALT, 90),
superficial circumflex iliac artery perforator (SCIP, 20), anteromedial thigh
(AMT, 5), upper medial thigh (UMT, 3), and other perforator free flaps (3).
Correlation between the surgical outcome and preoperative risk factors were
analysed using logistic regression model. Total loss was seen in 10 cases and 111
free-tissue transfers were successful (flap survival rate of 91.7%). During
follow-up, limb was eventually lost in 17 patients and overall limb salvage rate
was 84.9% and the 5-year survival was 86.8%. Correlation between flap loss and 14
preoperative risk factors (computed tomography (CT) angiogram showing intact
numbers of major vessels, history of previous angioplasty, peripheral arterial
disease (PAD), heart problem, chronic renal failure (CRF), American Society of
Anaesthesiologists (ASA) physical status classification system, smoking, body
mass index (BMI), HBA1c, lymphocyte count, ankle-brachial index (ABI),
osteomyelitis, C-reactive protein (CRP) level and whether taking
immunosuppressive agents) were analysed. Significant odds ratio were seen in
patients who underwent lower extremity angioplasties (odds ratio: 17.590,
p<0.001), with PAD (odds ratio: 10.212, p=0.032) and taking immunosuppressive
agents after kidney transplantation (odds ratio: 4.857, p<0.041). Diabetic foot
reconstruction using free flaps has a high chance for success and significantly
increases the 5-year survival rate. Risk factors such as PAD, history of
angioplasties in the extremity and using immunosuppressive agents after
transplant may increase the chance for flap loss.
Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic
Surgeons. Published by Elsevier Ltd. All rights reserved.
DOI: 10.1016/j.bjps.2012.09.024
PMID: 23098584 [Indexed for MEDLINE]
