Flaps for lower limb diabetic wound reconstruction: A systematic review and meta-analysis

Tan, Choon Han; Wu, Yanru; Satkunanantham, Mala

doi:10.1016/j.bjps.2023.01.032

Cited by 3 publications

(2 citation statements)

References 75 publications

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“…The use of free tissue transfer for DFU reconstruction has been controversial due to factors such as poor blood glucose control, DPN, PAD, ESRD and infection. Recent studies showed that the success rate of free tissue reconstruction for DFUs is about 92%, 15,31 with a complete loss rate of 7.14% 32 . Free flaps can reduce amputation and mortality rates, 15,31,33–35 with limb salvage rates ranging from 83.4% to 93.7% 15,31,34 .…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies showed that the success rate of free tissue reconstruction for DFUs is about 92%, 15 , 31 with a complete loss rate of 7.14%. 32 Free flaps can reduce amputation and mortality rates, 15 , 31 , 33 , 34 , 35 with limb salvage rates ranging from 83.4% to 93.7%. 15 , 31 , 34 Oh et al 34 reported a limb salvage rate of 84.9% and a 5‐year survival rate of 86.8% after an average follow‐up of 53.2 months.…”

Section: Discussionmentioning

confidence: 99%

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Combining antibiotic‐loaded bone cement‐based free vastus lateralis muscle‐sparing flap with split‐thickness skin grafts: A reliable strategy for reconstructing diabetic foot ulcers at non‐weight‐bearing areas

Chang,

Jian,

Liu

et al. 2024

International Wound Journal

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Diabetic foot ulcers (DFUs) present significant challenges due to their associated amputation rates, mortality, treatment complexity and excessive costs. Our earlier work introduced a wound surgical integrated treatment (WSIT) for DFUs, yielding promising outcomes. This study focuses on a specific WSIT protocol employing antibiotic‐loaded bone cement (ALBC) in the first Stage, and free vastus lateralis muscle‐sparing (VLMS) flaps and split‐thickness skin grafts (STSGs) in the second stage to repair non‐weight‐bearing DFUs. From July 2021 to July 2023, seven DFU patients (aged 47–71 years) underwent this treatment. Demographic data, hospital stay and repair surgery times were collected. Histological and immunohistochemical analyses assessed angiogenesis, collagen deposition and inflammation. SF‐36 questionnaire measured pre‐ and postoperative quality of life. Preoperative ultrasound Doppler showed that the peak blood flow velocity of the recipient area artery was significantly >30 cm/s (38.6 ± 6.8 cm/s) in all patients. Muscle flap sizes varied from 8 × 3.5 × 1 to 18 × 6 × 2 cm. The operation time of the repair surgery was 156.9 ± 15.08 minutes, and the hospital stay was 18.9 ± 3.3 days. Histological analysis proved that covering DFUs with ALBC induced membrane formation and increased collagen, neovascularization and M2 macrophages fraction while reducing M1 macrophages one. All grafts survived without amputation during a 7‐ to 24‐month follow‐up, during which SF‐36 scores significantly improved. A combination of ALBC with free VLMS flaps and STSGs proved to be safe and effective for reconstructing non‐weight‐bearing DFUs. It rapidly controlled infection, enhanced life quality and foot function, and reduced hospitalization time. We advocate integrating this strategy into DFU treatment plans.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Combining antibiotic‐loaded bone cement‐based free vastus lateralis muscle‐sparing flap with split‐thickness skin grafts: A reliable strategy for reconstructing diabetic foot ulcers at non‐weight‐bearing areas

Chang,

Jian,

Liu

et al. 2024

International Wound Journal

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A nomogram for predicting outcomes following pedicled flap reconstruction of the lower extremity

Bernuth,

Panayi,

Didzun

et al. 2024

Journal of Plastic, Reconstructive & Aesthetic Surgery

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The Webspace Toe Fillet Flap: A Variant Fillet Flap for Wound Closure After Asymmetric Amputation of 2 Adjacent Toes

Yammine,

Mouawad,

Jamaleddine

2024

Techniques in Foot &Amp; Ankle Surgery

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Wound closure after toe amputation for dysvascular necrosis of the toes extending proximally to the metatarsophalangeal joint could be challenging. When necrosis asymmetrically involves 2 adjacent toes, the healthy tissue of the partially necrotic toe could be used as a spare part for surgical wound closure after amputation. This paper reports a variant of the toe fillet flap, the webspace toe fillet flap, which could be performed when facing this clinical situation. After the amputation of the totally necrotic toe at the metatarsophalangeal joint level, the necrotic part of the partially necrotic toe is removed while preserving all the proximal healthy soft tissue, including the neurovascular elements. Therefore, closure is achieved using an axial-pattern digital flap rather than a random flap. In some instances, when necrosis is more distal, the proximal phalanx could be preserved and used as a spacer in the webspace that could possibly avoid lateral clawing of the remaining toes. The webspace toe fillet flap could be an excellent solution for wound closure after asymmetric amputation of 2 adjacent toes. Levels of Evidence: Level V, expert opinion.

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Flaps for lower limb diabetic wound reconstruction: A systematic review and meta-analysis

Cited by 3 publications

References 75 publications

Combining antibiotic‐loaded bone cement‐based free vastus lateralis muscle‐sparing flap with split‐thickness skin grafts: A reliable strategy for reconstructing diabetic foot ulcers at non‐weight‐bearing areas

Combining antibiotic‐loaded bone cement‐based free vastus lateralis muscle‐sparing flap with split‐thickness skin grafts: A reliable strategy for reconstructing diabetic foot ulcers at non‐weight‐bearing areas

A nomogram for predicting outcomes following pedicled flap reconstruction of the lower extremity

The Webspace Toe Fillet Flap: A Variant Fillet Flap for Wound Closure After Asymmetric Amputation of 2 Adjacent Toes

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