Abstract
Background: Diabetic foot lesions are often complicated by angiopathy and neuropathy. If a deep ulcer or osteomyelitis is present, there is often exposure of the underlying bone or tendon after aggressive debridement. Owing to recent advancements in microsurgery, such lesions can now be managed successfully with free flap reconstruction. Aim and Objectives: This study was aimed to evaluate the outcome of diabetic foot salvage using free flap reconstruction. Materials and Methods: Between January 2003 and June 2009, patients with diabetic foot and managed with free flap reconstruction in Buddhist Tzu-Chi General Hospital were reviewed. The flap types, success rate and complication rate were analyzed. Results: Forty-six patients (28 males and 18 females) with diabetic foot were reconstructed with a total of 48 free flaps. The mean age was 52.4 years (range from 27 to 79). The different kinds of free flaps that were used were: 25 vastus lateralis flaps, 10 anterolateral thigh flaps, 8 radial forearm flaps, 2 rectus abdominis flaps, 1 rectus femoris flap, 1 gracilis flap and 1 lateral leg flap. The complication rate was 41.7%. This included: total flap loss (1), partial flap loss (2), wound infection (9), loss of split thickness skin graft (4), venous thrombosis (2), hematoma (1) and pedicle bleeding (1). The infection rate was higher in the free muscle flap group (25%) than in the myocutaneous flap group (0%) or the fasciocutaneous flap group (11.8%). There were no perioperative mortalities. The mean follow-up was 15.0 months (range from 1 to 59). The limb salvage rate was 97.8%. Conclusion: In selected cases, diabetic foot lesions can be managed successfully with free flap reconstruction. There is a good outcome with an acceptable complication rate.
Published Version
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