The Role Of The Microsurgical Tissue Transfer In Diabetic Foot Ulcer: Completing The Most Functional Healing
DONGHYEOK SHIN, DONGKUN JEON.
Konkuk University Medical Center, Seoul, Korea, Republic of.
Background: The majority of diabetic foot ulcer (DFU) patients have occlusive peripheral arterial disease, many microsurgeons tend to hesitate performing free flap for DFU reconstruction, especially, when the occlusive peripheral arterial disease (PAD) is complicated. Nowadays, the application of free flap for DFU is increased and high success rate is reported, however, it has not been universal. We would like to notice our results and discuss the role and worth of the free flap in the DFU reconstruction. Methods: From September 2010 to August 2017, 171 free flap operations were performed for 168 patients. All ulcers were invaded into bony level through fascia and tendon with infection. The preoperative PTA was done if indicated and every patient was fully evaluated for medical and anesthesiological problem. After completion of wound bed preparation, the free tissue transfer was performed. Results: Preoperative PTA were done in 116 patients(68%) and 17 patients (10%) had end-stage renal disease (ESRD). 141 flaps of 171 flaps showed complete flap survival (82%) and 11 flaps were partially necrotized. Overall flap survival rate was 89%. Among 19 total flap necrosis, 10 flaps were replaced with skin graft, six were healed with dressing, and three were treated with below knee amputation (BKA). With exception of patients treated with BKA, the other patients are able to walk with own their feet and satisfied very highly in both terms of function and aesthetics. Conclusions: Our results showed overall success rate of 89 % that is not too low to look away free flap in DFU. The preoperative PAD and ESRD seemed to have negligible value on free flap survival in DFU. Because most of DFU occur on the plantar where has a role for weight bearing, free flap is more superior to other reconstruction method like skin graft or secondary healing. According to our results and experiences, I would like to highly recommend free flap for DFU for the best functional and aesthetic outcomes.
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