A Systematic Review of Free Tissue Transfer in the Management of Non-traumatic Lower Extremity Wounds in Patients with Diabetes

O’Connor, Elizabeth; Veselý, Martin; Holt, Peter; Jones, Katie; Thompson, Matt; Hinchliffe, Robert J.

doi:10.1016/j.ejvs.2010.11.013

Cited by 80 publications

(43 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…39,40 Some authors report the use of NPWT will reduce the frequency of debridement required in diabetic foot wounds, and its application is unlikely to reduce the efficacy of topical antibiotics in a preclinical animal model. 41 Assessment and input by the plastic surgeons is sought early. Where required, lower limb revascularization is prioritized to treat the peripheral arterial disease.…”

Section: Local Antibiotic Loadingmentioning

confidence: 99%

“…Thereafter, skin grafting, or a similar form of plastic surgical procedure, may be performed to achieve soft tissue coverage of the wound, and follow the reconstructive ladder. 41 Residual bony instability or deformity can be managed with a brace or surgical stabilisation. A second stage of definitive fixation may be performed at this time point.…”

Section: Local Antibiotic Loadingmentioning

confidence: 99%

See 1 more Smart Citation

Surgical management of the acute severely infected diabetic foot – The ‘infected diabetic foot attack’. An instructional review

Ahluwalia

Reichert

2021

Journal of Clinical Orthopaedics and Trauma

View full text Add to dashboard Cite

Diabetic Foot Infection (DFI), in its severest form the acute infected 'diabetic foot attack', is a limb and life threatening condition if untreated. Acute infection may lead to tissue necrosis and rapid spread through tissue planes, in the patient with poorly controlled diabetes facilitated by the host status. A combination of soft tissue infection and osteomyelitis may co-exist, in particular if chronic osteomyelitis serves as a persistent source for recurrence of soft tissue infection. This "diabetic foot attack" is characterised by acutely spreading infection and substantial soft tissue necrosis.In the presence of ulceration, the condition is classified by the Infectious Diseases Society of America/ International Working Group on the Diabetic Foot (IDSA/IWGDF Class 3 or 4) presentation requiring an urgent surgical intervention by radical debridement of the infection. Thus, 'time is tissue', referring to tissue salvage and maximal limb preservation. Emergent treatment is important for limb salvage and may be life-saving. We provide a narrative current treatment practices in managing severe DFI with severe soft tissue and osseous infection. We address the role of surgery and its adjuvants, the long term outcomes, potential complications and possible future treatment strategies.

show abstract

Section: Local Antibiotic Loadingmentioning

confidence: 99%

Section: Local Antibiotic Loadingmentioning

confidence: 99%

Surgical management of the acute severely infected diabetic foot – The ‘infected diabetic foot attack’. An instructional review

Ahluwalia

Reichert

2021

Journal of Clinical Orthopaedics and Trauma

View full text Add to dashboard Cite

show abstract

“…However, as microsurgical skills have developed, free tissue transfer can now allow extensive amputation to be avoided. [ 21 ] Removing bones with osteomyelitis is unavoidable, [ 22 ] but free tissue transfer can save soft tissue as much as possible. As a result, the length of the extremity can be preserved to the greatest extent possible.…”

Section: Discussionmentioning

confidence: 99%

The appropriate management algorithm for diabetic foot

et al. 2018

View full text Add to dashboard Cite

Background:Diabetic foot management is a challenge for reconstructive surgeons because it combines dramatically decreased circulation and chronic infection. The goal of managing this condition is to maximize viable tissue; however, unsatisfactory results, such as extremity amputation, are unavoidable in some cases. For appropriate management, thorough understanding of diabetic foot and the phased approach to its management is needed. The purpose of this study is to introduce an optimal algorithm for diabetic foot management by analyzing cases >12 years.Methods:A total of 274 patients with diabetic foot at Hanyang University Guri Hospital from 2005 to 2017 were reviewed. The management process was divided into 5 steps: patient evaluation, wound preparation, improving vascularity, surgery and dressing, and rehabilitation. Patient evaluation included a microbial culture, evaluation of vascularity, and an osteomyelitis assessment. During wound preparation, debridement and negative-pressure wound therapy were performed. Vascularity was improved by radiological intervention or surgical method. Surgery and dressing were performed depending on the indications. Rehabilitation was started after complete wound healing.Results:An infection was confirmed in 213 of 263 patients (81.0%). Of 74 cases in which a vascular study was performed, 83.8% showed arterial occlusion. When surgery was performed with complete eradication of the infection in 155 patients, the rate of revision surgery was 20.6%. The revision rate after surgery with a remnant infection of 66 patients was 40.9% (P = .0003). When surgery was performed after successful revascularization for improving blood flow of 47 patients, the rate of revision surgery was 21.3%. In contrast, the revision rate after surgery with unsuccessful or no revascularization of 174 patients was 28.2% (P = .359).Conclusion:Diabetic foot is a debilitating disease arising from multifactorial process. As its management is complex, a comprehensive but accessible treatment algorithm is needed for successful results. For this reason, the appropriate algorithm for diabetic foot management introduced in this study is significant.

show abstract

“…Certainly, for some procedures, such as tissue grafting, ensuring an uninfected surgical field is crucial. One systematic review of 18 studies of lower extremity wounds in diabetic patients identified infection as the main cause for early flap loss [40]. In non-infected flaps, lack of healing was associated with anastomotic failures, local thromboses, stress on the graft edges, or arteriopathy [40].…”

Section: Surgical Reconstructionmentioning

confidence: 99%

Treating Diabetic Foot Osteomyelitis: A Practical State-of-the-Art Update

Lipsky

Uçkay

2021

Medicina

View full text Add to dashboard Cite

Background and Objectives: Diabetic foot osteomyelitis (DFO) can be difficult to treat and securing optimal clinical outcomes requires a multidisciplinary approach involving a wide variety of medical, surgical and other health care professionals, as well as the patient. Results of studies conducted in the past few years have allowed experts to formulate guidelines that can improve clinical outcomes. Material and Methods: We conducted a narrative review of the literature on treat- ment of DFO, with an emphasis on studies published in the last two years, especially regarding antimicrobial therapies and surgical approached to treatment of DFO, supplemented by our own extensive clinical and research experience in this field. Results: Major amputations were once com- mon for DFO but, with improved diagnostic and surgical techniques, “conservative” surgery (foot- sparing, resecting only the infected and necrotic bone) is becoming commonplace, especially for forefoot infections. Traditional antibiotic therapy, which has been administered predominantly in- travenously and frequently for several months, can often be replaced by appropriately selected oral antibiotic regimens following only a brief (or even no) parenteral therapy, and given for no more than 6 weeks. Based on ongoing studies, the recommended duration of treatment may soon be even shorter, especially for cases in which a substantial portion of the infected bone has been resected. Using the results of cultures (preferably of bone specimens) and antimicrobial stewardship princi- ples allows clinicians to select evidence-based antibiotic regimens, often of a limited pathogen spec- trum. Intra-osseous antimicrobial and surgical approaches to treatment are also evolving in light of ongoing research. Conclusions: In this narrative, evidenced-based review, taking consideration of principles of antimicrobial stewardship and good surgical practice, we have highlighted the recent literature and offered practical, state-of-the-art advice on the antibiotic and surgical management of DFO.

show abstract

A Systematic Review of Free Tissue Transfer in the Management of Non-traumatic Lower Extremity Wounds in Patients with Diabetes

Cited by 80 publications

References 49 publications

Surgical management of the acute severely infected diabetic foot – The ‘infected diabetic foot attack’. An instructional review

Surgical management of the acute severely infected diabetic foot – The ‘infected diabetic foot attack’. An instructional review

The appropriate management algorithm for diabetic foot

Treating Diabetic Foot Osteomyelitis: A Practical State-of-the-Art Update

Contact Info

Product

Resources

About