Reconstruction of diabetic lower leg and foot soft tissue defects using thoracodorsal artery perforator chimeric flaps.

Abstract

Reconstruction of complicated diabetic lower leg and foot defects involving multiple tissue components remains a challenge. The purpose of this report is to introduce thoracodorsal artery perforator (TDAP) chimeric flaps for reconstructing diabetic lower leg and foot soft tissue defects. Between April 2010 and August 2016, 17 patients with multiple diabetic lower leg and foot defects underwent reconstruction with TDAP chimeric flaps. Nine were women and the mean age of the patients was 57.7years (range 35-73years). One patient had 3 separate defects, 14 patients had 2 separate defects, and 2 patients had defects with dead space. The size of the defects ranged from 5×3cm to 20×10cm. Fifteen patients received TDAP chimeric flaps with two components (skin and muscle components), and two received three components (skin, latissimus dorsi (LD), and serratus anterior [SA] components). The skin paddle ranged from 10×3cm to 25×14cm. The LD components ranged from 3×5cm to 20×10cm and SA components ranged from 5×2cm to 8×7cm. All flaps survived except for partial loss of one muscle component. Four patients suffered postoperative complications including wound disruption and infection, all of which healed conservatively. The mean follow-up was 31.3months (range 8-60months). Fifteen patients were able to walk, one patient walked with walker, and one patient who had amputation due to Charcot joint infection walked with prosthesis. The TDAP chimeric flap may be another option for the complicated and complex wound coverage required to reconstruct diabetic lower leg and foot soft tissue defects.