Diabetic foot resurfacing using microvascular tissue transfer from lateral thoracic region

Abstract

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.

Analysis of Operation Duration in Thoracodorsal Artery Perforator Free-Flap Surgery of the Lower Extremities

“…The TDAP flap has several benefits, including the ability to harvest a long pedicle, a scar that can be concealed, and no hair growth or color differences, making it an excellent option for flap transfer. 3,12,13 Despite these advantages, there have been fewer reports on the TDAP flap than those on other flaps. This may be attributed to the misconception that it can only be performed in a lateral or prone position.…”

Outcomes and Complications of Sole Reconstruction Using Lateral Thoracic Free Tissue Transfer

“…26 The skin of the flap matches the foot's robustness 7 and low morbidity and has long, reliable vascular pedicle (>15 cm). [8][9][10] These characteristics offer numerous benefits, which include preserving recipient tissue, reducing flap overharvesting, and allowing end-to-side arterial anastomoses with proximal vessels, which is particularly important for diabetic patients. In addition, separate hindfoot donor sites enable faster 2-team surgeries.…”

“…7 Moreover, it has low donor site morbidity and provides a relatively long and dependable vascular pedicle (>15 cm). [8][9][10] Consequently, a lateral thoracic free flap can supply versatile and adequate flaps to satisfy the requirements for reconstructing large-scale defects of the sole.…”

“…A lateral thoracic free flap offers a thick skin tissue that closely resembles the skin of the foot, which is some of the thickest skin on the body 7 . Moreover, it has low donor site morbidity and provides a relatively long and dependable vascular pedicle (>15 cm) 8–10 . Consequently, a lateral thoracic free flap can supply versatile and adequate flaps to satisfy the requirements for reconstructing large-scale defects of the sole.…”