A New Approach for Reconstruction of Diabetic Foot Wounds Using the Angiosome and Supermicrosurgery Concept

Suh, Hyun Suk; Oh, Tae Suk; Lee, Ho Seung; Lee, Seung Hwan; Cho, Yong Pil; Park, Joong Ryul; Hong, Joon Pio

doi:10.1097/prs.0000000000002401

Cited by 80 publications

(85 citation statements)

References 26 publications

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“…The exact roles of endovascular and open bypass procedures are still evolving, but are primarily determined by arterial anatomy, wound severity, and patient comorbidities . Whatever the method, it is imperative to restore as much blood flow as possible to the foot so it can be adequately used as a recipient vessel . The orthopaedic surgeons or podiatrists need to be involved to evaluate the skeletal status of the lower leg or foot when indicated.…”

Section: Patient Selection Multidisciplinary Approach and The Woundmentioning

confidence: 99%

“…The understanding of vascular distribution of the foot, angiosome, helps to plan not only reconstruction but debridement especially in legs with limited vascularity . Performing debridement according to the angiosome territory, one may enhance flap survival by increasing the chance for marginal vascularisation from healthy surrounding angiosome territory . Repetitive debridement should be performed as part of wound preparation for reconstruction while monitoring c‐reactive protein for possible hidden infections and using it as an index for possible infection after reconstruction.…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…One of the basic elements of plastic surgery is to replace like with like. Thus for defects with skin defects, we are shifting towards using perforator flaps such as anterolateral thigh (ALT) perforator flap, thoracodarsal artery perforator (TDAP) flap, and superficial circumflex iliac perforator (SCIP) flap as it provides, a thin flap to minimise shearing, can take only the superficial fat to imitate the fibrous septa of the sole to adhere tightly, enhance neovascularisation of the subdermal plexus with adjacent tissue, and provide adequate blood supply to fight infection . The elevation technique of each individual flap is described in detail in the referenced articles.…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…Nylon 9‐0 or 10‐0 sutures can be used to anastomose vessels of 1 to 2 mm diameters. Recently, a new technique called supermicrosurgery is being used to anastomose vessels at a perforator level . The concept of supermicrosurgery introduced by Koshima et al has increased the popularity of perforator flaps and lymphatic surgery anastomosing vessels ranging from 0.3 to 0.8 mm in diameter .…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…The collateral vessels usually develop over the ischaemic transition period allowing alternative circulation of the skin of the distal leg and foot . These collateral vessels will often originate from the adjacent angiosome territory and when this formation of collateral is not enough, the skin will start to deteriorate as oxygen supply slowly diminishes . The reconstruction by perforator flap using the supermicrosurgery approach provides well‐vascularised tissue that covers diabetic foot defect without being dependent on major vessels.…”

Section: Surgical Techniquesmentioning

confidence: 99%

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The role of reconstructive microsurgery in treating lower‐extremity chronic wounds

Suh

Hong

2019

International Wound Journal

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Frequently considered chronic wounds for reconstruction are wounds lacking healing progress despite good wound care. And those needing microsurgical reconstruction are chronic wounds that are unable to close by local flap or skin grafts, wounds with exposed vital structure such as tendon and bones, and wounds that have prolonged infections such as osteomyelitis and skin necrosis. The reconstruction for soft tissue defects not only aims to provide coverage but to restore function and acceptable form as well. Wound preparation prior to microsurgical reconstruction consists of improving or restoring vascular supply, stabilising skeletal structures, and obtaining clinically clean wounds. Microsurgery is a surgical discipline that combines magnification with a advanced microscope, specialised precision tools, and various operating techniques. Thus microsurgery allows flap to be transferred far from the donor site restoring form and function to areas of the body that have lost skin, fat, muscle movement, and/or skeletal support. Microsurgery has expanded reconstructive surgery's elements and strategies and is still evolving.Along with the multidisciplinary approach and good principle of wound care, the repair and restoration strategies using microsurgery have widened the possibilities for limb salvage from complex chronic wounds.

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Section: Patient Selection Multidisciplinary Approach and The Woundmentioning

confidence: 99%

Section: Surgical Techniquesmentioning

confidence: 99%

Section: Surgical Techniquesmentioning

confidence: 99%

Section: Surgical Techniquesmentioning

confidence: 99%

Section: Surgical Techniquesmentioning

confidence: 99%

See 3 more Smart Citations

The role of reconstructive microsurgery in treating lower‐extremity chronic wounds

Suh

Hong

2019

International Wound Journal

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Role of the Plastic Surgeon in Diabetic Foot Care

Hong

Suh

2020

The Foot in Diabetes

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Diabetic foot resurfacing using microvascular tissue transfer from lateral thoracic region

Chang

Jang²,

Kim

et al. 2022

Diabetes Metabolism Res

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Aims Diabetic foot ulcer is a major complication of diabetes mellitus and amputation is often needed. Since mortality rate after amputation is comparatively high, saving diabetic foot is required not only for preserving function and life quality, but also for decreasing mortality rate. This study was designed to analyse experience of limb salvage in patients with diabetic foot using free flaps from the lateral thoracic region over a 10‐year period. Materials and Methods Between 2009 and 2018, 297 cases of diabetic foot underwent surgical procedures. We analysed the 83 cases who underwent free flap from lateral thoracic region. Patient data were reviewed retrospectively. Results A total of 83 patients, 56 of them males, were included in this study. Age of patients ranged from 27 to 80 years. Twenty patients underwent percutaneous transluminal angioplasty procedures. The latissimus dorsi muscle sparing technique was used in 7 cases. A thoracodorsal artery perforator flap was used in 68 cases. A thoracodorsal artery perforator chimaeric flap was performed in 8 cases. The flap survival rate was 98.8% and the limb salvage rate was 96.4%. The mean follow‐up was 6.5 years. During follow‐up 14 patients suffered recurrence of foot ulcers. Conclusions Ten‐year experience of using flaps from the lateral thoracic region revealed superior outcomes in terms of flap survival and limb saving compared to those in a recent meta‐analysis and other reports. Long vascular pedicle technique and the chimaeric technique might be the alternative methods for multiple or vascular insufficient diabetic foot defects.

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A New Approach for Reconstruction of Diabetic Foot Wounds Using the Angiosome and Supermicrosurgery Concept

Abstract: Therapeutic, IV.

Cited by 80 publications

References 26 publications

The role of reconstructive microsurgery in treating lower‐extremity chronic wounds

The role of reconstructive microsurgery in treating lower‐extremity chronic wounds

Role of the Plastic Surgeon in Diabetic Foot Care

Diabetic foot resurfacing using microvascular tissue transfer from lateral thoracic region

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