Use of local intrinsic muscle flaps for diabetic foot and ankle reconstruction: a systematic review

Abstract

Although local intrinsic muscle flaps demonstrated a relatively high success rate when used for the definitive closure of certain diabetic foot and ankle wounds based on existing evidence, our systematic review emphasises the need for more high-quality, larger comparative studies to investigate their efficacy and failure rates in diabetic foot and/or ankle reconstruction.

Diagnosis and treatment of diabetic foot ulcer complicated with lower extremity vasculopathy: Consensus recommendation from the Chinese Medical Association (CMA), Chinese Medical Doctor Association (CMDA)

“…Recent studies have confirmed that free flaps can improve the local blood supply, reduce the rate of lower extremity amputation and improve the five‐year survival rate and can be used in patients with mild vasculopathy or those who have undergone vascular reconstruction surgery 77,78 . In addition, local flaps are often applied and advantageous in the surgical repair of small‐scale diabetic foot ulcers because they cause minor damage, can be placed in close proximity to tissues and accelerate the return of normal sensation to cutaneous nerves 79,80 Toe/lower extremity amputation : Toe/lower extremity amputation can be performed when refractory wounds seriously affect the patient's quality of life or when the toe/extremity has lost its functionality and has no preservation value or is life‐threatening 81 .…”

“…73 77,78 In addition, local flaps are often applied and advantageous in the surgical repair of small-scale diabetic foot ulcers because they cause minor damage, can be placed in close proximity to tissues and accelerate the return of normal sensation to cutaneous nerves. 79,80 (9) Toe/lower extremity amputation: Toe/lower extremity amputation can be performed when refractory wounds seriously affect the patient's quality of life or when the toe/extremity has lost its functionality and has no preservation value or is lifethreatening. 81 The level of diabetic foot amputation is closely related to the patient's nutritional status, the state of the skin of the affected extremity, the presence or absence of arterial occlusion or neuropathy and infection severity.…”

DermaClose: A Case Series in the Management of Large Soft Tissue Defects in Diabetic Foot Infection

“…One study, which undertook STSG in 83 patients with diabetic foot and ankle wounds, concluded a 65% success rate of no graft failure. The paper comments that a further 28% of the cohort healed with a second grafting procedure 6 . As there is a high infection risk in this cohort of patients, converting the single wound that they originally presented with to up to 3 wounds due to the STSG donor site(s) may represent an unacceptable risk.…”

“…Distant lower limb muscle, perforator, and pedicle flaps are often not amenable as the recipient site on the foot and ankle is too distant. 6 Furthermore, distal limb local flaps that rely on good microvascular circulation for flap success inherently carry a high risk of failure in patients with diabetes. Consideration of a free flap in this population may be appropriate as their macrovasculature is less severely affected by the pathology.…”

“…Management of diabetic foot and ankle wounds with local and free tissue transfers are discussed in the literature with local intrinsic muscle flaps being most often selected, 6 but these are not without complication. Distant lower limb muscle, perforator, and pedicle flaps are often not amenable as the recipient site on the foot and ankle is too distant 6 . Furthermore, distal limb local flaps that rely on good microvascular circulation for flap success inherently carry a high risk of failure in patients with diabetes.…”