Flap Reconstruction of Distal Lower Extremity Wounds in Diabetic Patients

Yan, Hede; Yang, Mei; Lineaweaver, William C.; Myers, Robert S.; Chen, Henan; Zhang, Feng

doi:10.1097/sap.0b013e3181fab99e

Cited by 5 publications

(5 citation statements)

References 40 publications

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“…The effect of postoperative infection on increasing necrosis rates of pedicled and free flaps has already been reported in several studies. [29][30][31] In this study, the degree of systemic infection or inflammation was indirectly estimated through the C-reactive protein level. As a result, the level in the partial loss group was significantly higher preoperatively than in the non-partial loss group.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Partial Flap Loss in a Free Flap: A 12-Year Retrospective Study of Anterolateral Thigh Free Flap in 303 Lower Extremity Cases

Kim

Hong

Suh

2022

Plastic &Amp; Reconstructive Surgery

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Background: Despite remarkable improvements in free flap procedures, partial flap losses in perforator flaps still occur. This study aimed to analyze partial necrosis cases that underwent reconstruction of the lower extremities using anterolateral thigh free flaps and to identify risk factors causing the occurrence of partial necrosis. Methods: From January of 2005 to February of 2017, 303 anterolateral thigh free flaps were analyzed retrospectively. After collecting patient data, receiver operating characteristic curve analysis was conducted to find the critical distance between the perforator and the flap margin that distinguishes partial necrosis. Also, the rate of partial losses was calculated for each section after dividing the distance from the perforator to the flap margin into 1-cm sections. Lastly, logistic regression analyses were performed to identify the risk factors. Results: Forty-three cases had partial flap loss (14.19 percent). Flaps with supradeep fat layer elevation showed the highest rate of partial necrosis (25.53 percent), with statistical significance (p = 0.0001). In receiver operating characteristic curve analysis, the cutoff distance was 10.25 cm. In addition, flap tissues 8 cm away from the perforator have a 10.3 percent chance of necrosis, whereas those 12 cm away from the perforator have a 22.9 percent chance. Lastly, supradeep fat layer elevation (OR, 3.952) and large flap size (OR, 1.041) were risk factors for partial flap necrosis on multivariate analysis. Conclusions: The distance from the perforator to the flap margin, the flap elevation layer, and the flap size affected the occurrence of partial necrosis. Taking these into consideration, anterolateral thigh free flaps of appropriate size and thickness should be harvested. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Partial Flap Loss in a Free Flap: A 12-Year Retrospective Study of Anterolateral Thigh Free Flap in 303 Lower Extremity Cases

Kim

Hong

Suh

2022

Plastic &Amp; Reconstructive Surgery

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“…It has been shown that the attempt for diabetic limb salvage should be encouraged since this is the single way to decrease the amputation rate and to increase the long-term survival in the diabetic population (23, 24). Once the necessity for reconstructive surgery in salvaging the diabetic foot has been better understood, a growing number of surgical options were introduced.…”

Section: Discussionmentioning

confidence: 99%

The use of propeller perforator flaps for diabetic limb salvage: a retrospective review of 25 cases

Georgescu

Matei

Capota

2012

Diabetic Foot & Ankle

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BackgroundPeripheral vascular disease and/or diabetic neuropathy represent one of the main etiologies for the development of lower leg and/or diabetic foot ulcerations, and especially after acute trauma or chronic mechanical stress. The reconstruction of such wounds is challenging due to the paucity of soft tissue resources in this region. Various procedures including orthobiologics, skin grafting (SG) with or without negative pressure wound therapy and local random flaps have been used with varying degrees of success to cover diabetic lower leg or foot ulcerations. Other methods include: local or regional muscle and fasciocutaneous flaps, free muscle and fasciocutaneous, or perforator flaps, which also have varying degrees of success.Patients and methodsThis article reviews 25 propeller perforator flaps (PPF) which were performed in 24 diabetic patients with acute and chronic wounds involving the foot and/or lower leg. These patients were admitted beween 2008 and 2011. Fifteen PPF were based on perforators from the peroneal artery, nine from the posterior tibial artery, and one from the anterior tibial artery.ResultsA primary healing rate (96%) was obtained in 18 (72%) cases. Revisional surgery and SG for skin necrosis was performed in six (24%) cases with one complete loss of the flap (4%) which led to a lower extremity amputation.ConclusionsThe purpose of this article is to review the use of PPF as an effective method for soft tissue coverage of the diabetic lower extremity and/or foot. In well-controlled diabetic patients that present with at least one permeable artery in the affected lower leg, the use of PPF may provide an alternative option for soft tissue reconstruction of acute and chronic diabetic wounds.

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“…[1][2][3][4] The area of soft tissue defect in the skin of bilateral lower limbs is often large. To achieve limited incision, effective coverage, and restore lower limbs' shape in the recipient area, restore function, and minimize donor site injury, effective free flaps should be selected, such as greater omentum transplantation combined with a free skin graft, lobulated skin flap, or conjoined skin flap, [5][6][7] as they can effectively repair most wounds.…”

Section: Introductionmentioning

confidence: 99%

Deep Inferior Epigastric Flap Combined Bilateral-Anterolateral Thigh Flap for the Coverage of Both Lower Extremity Soft-Tissue Defect: A Case Report and a Literature Review

Huo

2021

CCID

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Background/Purpose: Anterolateral thigh perforator (ALTP) flap and deep inferior epigastric perforator (DIEP) flap have been advantageous over traditional myocutaneous flaps as they preserve the integrity of donor site muscles and minimize the damage and complication to donor site structures. Here, we reported the efficacy of free ALTP and DIEP in the repair of large skin area and soft tissue defects on both lower limbs after trauma. Case Report: A 19-year-old female traffic accident victim presented with multiple open bilateral fractures to the lower extremities with joint dislocation, massive skin and soft tissue defects, and multiple soft tissue contusion. Wounds on both lower extremities were covered with VSD (Vacuum Sealing Drainage). The tibiofibular and ankle joints on both lower limbs were fixed using external fixators. DIEP and ALTP flap were performed at different times. Results: After transfer, the vascular pedicle was anastomosed to the anterior tibial artery, posterior tibial artery, and the accompanying vein. After the operation, the donor site was directly closed and sutured. All flaps survived with a good appearance, leaving only a linear scar at the donor site. Conclusion: This case shows that free ALTP and DIEP flaps are ideal for repairing large skin area and soft tissue defects in bilateral lower limbs after trauma.

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Flap Reconstruction of Distal Lower Extremity Wounds in Diabetic Patients

Cited by 5 publications

References 40 publications

Risk Factors for Partial Flap Loss in a Free Flap: A 12-Year Retrospective Study of Anterolateral Thigh Free Flap in 303 Lower Extremity Cases

Risk Factors for Partial Flap Loss in a Free Flap: A 12-Year Retrospective Study of Anterolateral Thigh Free Flap in 303 Lower Extremity Cases

The use of propeller perforator flaps for diabetic limb salvage: a retrospective review of 25 cases

Deep Inferior Epigastric Flap Combined Bilateral-Anterolateral Thigh Flap for the Coverage of Both Lower Extremity Soft-Tissue Defect: A Case Report and a Literature Review

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