Abstract
BackgroundThe combination of endovascular intervention and microvascular free flap transfer has been effectively used for chronic ischemic wounds of lower limb. The aim of this study was to determine the influence of angioplasty on free flap survival in diabetic foot ulcer reconstruction.MethodsA retrospective research was conducted for 46 diabetic patients with chronic ulcer of the foot. All patients underwent free flap reconstruction because of their non-healing wound with tendon or bone exposure. Patient’s demography, clinical data related to vascular status, vascular intervention, and free flap transfer procedure were collected. Flap survival rate was compared between the group with severe arterial stenosis group and non-severe stenosis group. It was also compared among groups with different revascularization results.ResultsThe average age of patients was 56.2 ± 10.8 years. There were 14 (30.4%) men and 32 (69.6%) women. Of 46 patients, 23 (50%) had severe infrapopliteal arterial stenosis. All 23 patients underwent endovascular intervention. Their final results of the pedal arch were type 1 in 13 patients, type 2A in 7 patients, type 2B in 2 patients, and type 3 in 1 patient. Total flap necrosis was found in 5 (10.9%) cases, marginal necrosis in 4 (8.7%) cases, and wound dehiscence in 4 (8.7%) cases. There was no significant difference in flap loss between severe arterial stenosis patients and non-severe arterial stenosis patients. In the severe arterial stenosis group, after endovascular intervention, patients with type 1 of pedal arch had a significantly lower rate of total flap necrosis than others. There was no association between the use of revascularized recipient artery and flap survival.ConclusionsOur study revealed that the quality of pedal arch was crucial for free flap survival. Thus, PTA should aim to re-establish a complete pedal arch to increase wound healing rate and flap success.
Highlights
The combination of endovascular intervention and microvascular free flap transfer has been effectively used for chronic ischemic wounds of lower limb
After endovascular intervention was introduced with several advantages, it has replaced the bypass surgery to be the primary indication in critical limb ischemia management [5]
Numerous studies have investigated the combination of preoperative angioplasty and microvascular free flap surgery
Summary
The combination of endovascular intervention and microvascular free flap transfer has been effectively used for chronic ischemic wounds of lower limb. The aim of this study was to determine the influence of angioplasty on free flap survival in diabetic foot ulcer reconstruction. In 1985, Brigg et al first combined vascular bypass surgery and free tissue transfer to reconstruct an ischemic lower limb [4]. Numerous studies have investigated the combination of preoperative angioplasty and microvascular free flap surgery. We reviewed our patients who underwent microvascular free flap reconstruction because of diabetic foot ulcers. Our purpose was to determine the impact of endovascular revascularization on the success of free flap and to explore the other risk factors of microvascular surgery after angioplasty
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