Diabetic foot reconstruction with free flaps pays dividends

Diabetic foot reconstruction using free flaps has high success and survival rates, say researchers.

Joon Hong (University of Ulsan, Songpa-gu, Seoul, South Korea) and colleagues found that of 121 cases of diabetic foot reconstruction, total loss was seen in 10 cases, of which four were due to congestion, one to arterial insufficiency, and five to slow flap deterioration.

They found that 111 free-tissue transfers were successful, corresponding to a flap survival rate of 91.7%.

During the follow-up period of 53.2 months, major amputation above the ankle was performed on 17 patients and the overall limb salvage rate was 84.9%.

Further analysis revealed that patients who underwent lower extremity angioplasties, those who had peripheral arterial disease, and those who took immunosuppressive agents after kidney transplantation were at a 17.6-, 10.2-, and 4.9-fold higher risk for flap loss than those without these risk factors.

Kaplan-Meir analysis showed that the 5-year survival rate was significantly higher for reconstructed patients compared with those who were amputated above the ankle, at 86.8% versus 41.4%.

"This strongly suggests that reconstruction rather than amputating above the ankle will increase the 5-year survival rate," write the authors in the Journal of Plastic, Reconstructive, and Aesthetic Surgery.

The study included 113 patients with an average age of 54.6 years who had a reconstructed diabetic foot. The free flaps used were anterolateral thigh, superficial circumflex iliac artery perforator, anteromedial thigh, upper medial thigh, and other perforator free flaps.

The researchers say of the findings: "There is no doubt that a well-revascularized free flap will enhance healing, quality of life and survival chances. Although there are risks for failure and the healing process is more complicated, it is worthwhile for the patient to recover their limb function."

Hong and team conclude: "Extra measures are advised to maximize the perfusion of the limb as well as increase the chance of flap survival."

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