Fitzgerald O'Connor EJ, Vesely M, Holt PJ, Jones KG, Thompson MM, Hinchliffe RJ, et al.
European journal of vascular and endovascular surgery : the official journal of the European So.... Date of publication 2011 Mar 1;volume 41(3):391-9.
1. Eur J Vasc Endovasc Surg. 2011 Mar;41(3):391-9. doi: 10.1016/j.ejvs.2010.11.013.
Epub 2010 Dec 16.
A systematic review of free tissue transfer in the management of non-traumatic
lower extremity wounds in patients with diabetes.
Fitzgerald O'Connor EJ(1), Vesely M, Holt PJ, Jones KG, Thompson MM, Hinchliffe
RJ.
Author information:
(1)St George's Vascular Institute, St Georges Healthcare NHS Trust, London, UK.
OBJECTIVES: Wounds of the lower limb in patients with diabetes are frequently
difficult to heal. Some wounds fail to heal despite optimal medical and surgical
care. This review examines the evidence for whether free tissue transfer
techniques may reduce the requirement of amputation in these patients.
DESIGN: A systematic review.
MATERIALS & METHODS: Pubmed, Embase, AMED, SCOPUS and CINAHL and Cochrane Library
were searched for all articles on free tissue transfer in lower limb wounds in
patients with diabetes (September 2010). Current experience, indications and
outcomes were analysed.
RESULTS: 528 patients from 18 studies were included in the systematic review. 66%
of patients had concomitant revascularisation with bypass surgery. 63% of flaps
were muscle based, 35% fasciocutaneous and 1.7% omental. Pooled in-hospital
mortality rate was 4.4%, flap survival was 92% and limb salvage rate of 83.4%
over a 28 months average follow-up time.
CONCLUSIONS: In conclusion free tissue transfer achieves successful wound healing
in selected patients with diabetes and difficult to heal wounds that would have
required amputation. Pre-operative optimisation of vascular supply and
eradication of infection is key to success. Objective wound assessment scores and
a clear multidisciplinary team (MDT) approach would improve patient care.
Copyright © 2010 European Society for Vascular Surgery. Published by Elsevier
Ltd. All rights reserved.
DOI: 10.1016/j.ejvs.2010.11.013
PMID: 21163675 [Indexed for MEDLINE]
