Ozkan O, Coşkunfirat OK, Ozgentaş HE, et al.
Microsurgery. Date of publication 2005 Jan 1;volume 25(2):107-12.
1. Microsurgery. 2005;25(2):107-12.
Reliability of free-flap coverage in diabetic foot ulcers.
Ozkan O(1), Coşkunfirat OK, Ozgentaş HE.
Author information:
(1)Department of Plastic and Reconstructive Surgery, Akdeniz University School of
Medicine, Antalya 07059, Turkey. omozkan@hotmail.com
As microsurgery advances, microsurgical free-tissue transfers have become the
reconstructive method of choice over staged or primary amputation, and enabling
independent ambulation in difficult lower-extremity wounds. In this report, we
present our experiences with free-tissue transfer for the reconstruction of
soft-tissue defects in 13 diabetic foot ulcers. Following radical debridement,
soft-tissue reconstruction was achieved in the following ways: anterolateral
thigh fasciocutaneous flap in 5 patients, radial forearm fasciocutaneous flap in
3 patients, lateral arm fasciocutaneous flap in 1 patient, gracilis
musculocutaneous flap in 1 patient, tensor fascia latae flap in 1 patient, deep
inferior epigastric perforator flap in 1 patient, and a parascapular flap in the
remaining patient. In 8 cases, diabetic wounds were in the foot, while wounds
were at the level of the lower leg in the remaining patients. In all patients,
vascular patency was confirmed by the Doppler technique. In suspicious cases,
arteriography was then performed. While all flaps survived well in the
postoperative period, one patient died from cardiopulmonary problems on
postoperative day 16 in an intensive care unit. Amputation was necessary in the
early postoperative period because of healing problems. In the remaining 10
cases, all flaps survived intact. In one case, arterial revision was performed
successfully. The ultimate limb salvage rate was 83% for the 12 patients.
Independent ambulation was achieved in these cases. During the follow-up period
of 8 months to 2 years, no ulcer recurrence was noted, and no revascularization
or vascular bypass surgery was needed before or after the free-tissue transfers.
The authors conclude that free-tissue transfer for diabetic foot ulcers is a
reliable procedure, despite pessimistic opinions regarding the flap survival and
low limb salvage rates. It should be considered a useful reconstructive option
for serious defects in well-selected cases.
(c) 2005 Wiley-Liss, Inc.
DOI: 10.1002/micr.20094
PMID: 15633172 [Indexed for MEDLINE]
