Abstract
IntroductionDiabetic foot ulcers occur in approximately 2,5% of patients suffering from diabetes and may lead to major infections and amputation. Such ulcers are responsible for a prolonged period of hospitalization and co- morbidities caused by infected diabetic foot ulcers. Small, superficial ulcers can be treated by special conservative means. However, exposed bones or tendons require surgical intervention in order to prevent osteomyelitis. In many cases reconstructive surgery is necessary, sometimes in combination with revascularization of the foot.There are studies on non surgical treatment of the diabetic foot ulcer. Most of them include patients, classified Wagner 1-2 without infection. Patients presenting Wagner 3D and 4D however are at a higher risk of amputation. The evolution of microsurgery has extended the possibilities of limb salvage. Perforator based flaps can minimize the donorsite morbidity.Patients and Methods41 patients were treated with free tissue transfer for diabetic foot syndrome and chronic defects. 44 microvascular flaps were needed. The average age of patients was 64.3 years. 18 patients needed revascularization. 3 patients needed 2 microvascular flaps. In 6 cases supramicrosurgical technique was used.ResultsThere were 2 flap losses leading to amputation. 4 other patients required amputation within 6 months postoperatively due to severe infection or bypass failure. Another 4 patients died within one year after reconstruction. The remaining patients were ambulated.DiscussionLarge defects of the foot can be treated by free microvascular myocutaneous or fasciocutaneous tissue transfer. If however, small defects, exposing bones or tendons, are not eligible for local flaps, small free microvascular flaps can be applied. These flaps cause a very low donor site morbidity. Arterialized venous flaps are another option for defect closure.Amputation means reduction of quality of life and can lead to an increased mortality postoperatively.
Highlights
Diabetic foot ulcers occur in approximately 2,5% of patients suffering from diabetes and may lead to major infections and amputation
Patients and Methods: 41 patients were treated with free tissue transfer for diabetic foot syndrome and chronic defects. 44 microvascular flaps were needed
This study describes our experience with standard microvascular- and supramicrovascular free flap closure in combination with bypass surgery of wounds caused by diabetic foot syndrome
Summary
Diabetic foot ulcers occur in approximately 2,5% of patients suffering from diabetes and may lead to major infections and amputation. Small defects, exposing bones or tendons, are not eligible for local flaps, small free microvascular flaps can be applied These flaps cause a very low donor site morbidity. It is very well understood that diabetic neuropathy is the major cause of ulcers In identifying these patients and treating them with neurolysis has shown to prevent ulcers and amputations [3]. In some cases local wound therapy is not indicated, especially in infected wounds with exposed bones, tendons, vessels or nerves. These wounds are classified as 3D or 4D (Wagner/Armstrong). 39% of patients survive 7 years postoperative [6,7]
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