Surgical revascularization and reconstruction procedures in diabetic foot ulceration

Abstract

This article summarizes surgical procedures for preservation of the foot in diabetic patients with peripheral artery disease. Distal bypass surgery performed to perigeniculate arteries and to an isolated ‘blind’ popliteal segment with visible collaterals can be performed with limb salvage rates close to what can be achieved with standard bypass to crural arteries. This is also the case when performing bypass to the dorsalis pedis artery. Bypass to the medial or lateral plantar artery or to the lateral tarsal artery is associated with a relatively high rate of early occlusion, but in the patients who have persistently open grafts, limb salvage is common. The use of an arteriovenous fistula as an adjunct to distal bypass surgery does not improve prognosis. Venous arterialization, either creating retrograde perfusion of the superficial or of the deep veins of the foot has been successful in several cases although it is difficult to predict which patients will benefit. Reconstructive surgery is often performed in a multidisciplinary team including plastic surgeons. In patients with need of more extensive cover of defects, the transplant of muscular or fasciocutaneous free flaps has provided good results in the few centres that have applied this technique. This procedure can be combined with a revascularization in the same session or at a later stage. A majority of the described techniques can be implemented in most vascular centres and they should be considered in complicated cases when standard methods of revascularization and reconstruction do not suffice.

Percutaneous Deep Foot Vein Arterialization IVUS-Guided in No-Option Critical Limb Ischemia Diabetic Patients

“…TcPO2 levels was recorded in all patients with a median number of measurements per patients of 12 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Median value increased from 8 + 2 mmHg (4-32 mmHg) before the AVF creation to 56 + 4 mmHg (48-75 mmHg) at 6 months after the procedure.…”

“…Mortality after major amputation in patients with diabetes is high, with 5-year mortality between 52% and 80% in various studies and is closely related to amputation level. 2 Revascularization, through either endovascular or surgical technique, could prevent amputation by increasing blood supply and, thereby, relieving pain and allowing wound healing. However, in about 14-20% of patients, the distribution of occlusive lesions is such that routine surgical or endovascular techniques cannot be applied.…”

Restoring blood flow to the lateral plantar artery after elevation of an instep flap or medialis pedis flap

“…The recipient vessels dorsalis pedis artery, the tarsal artery, and the medial or lateral plantar arteries in patients with critical limb ischemia. When compared to endovascular treatments like percutaneous transluminal angioplasty, bypass surgery has been considered the more effective type of revascularization [ 19 ].…”

Differences in initial versus recurrent diabetic foot ulcers at a specialized tertiary diabetic foot care center in China

“…13 Vascular intervention can ameliorate the blood supply to lower extremity blood vessels and supply ischemic tissue oxygen to a certain extent. [23][24][25] Vascular intervention is currently the main treatment for refractory ulcers and chronic ischemic disease of the lower extremities. Our study showed that patients in the recurrence group received vascular interventions five times more often than those in the initial group (see Table 3).…”