Grenzen und Möglichkeiten der Vermeidung von Majoramputationen der unteren Extremität bei Diabetischem Fußsyndrom und arterieller Verschlusskrankheit durch freien Gewebetransfer

Schirmer, Steffen; Ritter, R.; Rice, Ann Marie; Frerichs, O.; Wehage, I. C.; Fansa, Hisham

doi:10.1055/s-0031-1273685

Cited by 7 publications

(8 citation statements)

References 25 publications

(33 reference statements)

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“…Anastomosing those small vessels requires high microvascular skills. Majority of publications describe free microvascular muscle flaps or fascio-cutaneous flaps for reconstruction [12,37,38,39]. The 6 flaps in our study were used in smaller defects.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the flap hooked on the bypass increases the flow through by reducing distal resistance [12,26,27,28,29]. Long- time results have demonstrated a rate of over 50% of Limb salvage after combined bypass- surgery and free flap reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…The reconstructed poplito-pedal bypass with the hooked parascapular flap was also visualized. Bypass and flap anastomosis were patent; and the perfusion of the foot was increased [12]. …”

Section: Discussionmentioning

confidence: 99%

“…If necessary, free tissue transfer has to be performed. Several studies show that this can also be done successfully in older diabetic patients [11,12,32]. These patients, however, suffer from severe co- morbidities.…”

Section: Discussionmentioning

confidence: 99%

“…The concept of free tissue transfer has become an option for limb salvage in elderly patients suffering from diabetes. The success rate of free microvascular tissue transfer as described in publications on older diabetic patients is promising [11,12]. …”

Section: Introductionmentioning

confidence: 99%

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Vascular Surgery, Microsurgery and Supramicrosurgery for Treatment of Chronic Diabetic Foot Ulcers to Prevent Amputations

2013

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IntroductionDiabetic foot ulcers occur in approximately 2,5% of patients suffering from diabetes and may lead to major infections and amputation. Such ulcers are responsible for a prolonged period of hospitalization and co- morbidities caused by infected diabetic foot ulcers. Small, superficial ulcers can be treated by special conservative means. However, exposed bones or tendons require surgical intervention in order to prevent osteomyelitis. In many cases reconstructive surgery is necessary, sometimes in combination with revascularization of the foot.There are studies on non surgical treatment of the diabetic foot ulcer. Most of them include patients, classified Wagner 1-2 without infection. Patients presenting Wagner 3D and 4D however are at a higher risk of amputation. The evolution of microsurgery has extended the possibilities of limb salvage. Perforator based flaps can minimize the donorsite morbidity.Patients and Methods41 patients were treated with free tissue transfer for diabetic foot syndrome and chronic defects. 44 microvascular flaps were needed. The average age of patients was 64.3 years. 18 patients needed revascularization. 3 patients needed 2 microvascular flaps. In 6 cases supramicrosurgical technique was used.ResultsThere were 2 flap losses leading to amputation. 4 other patients required amputation within 6 months postoperatively due to severe infection or bypass failure. Another 4 patients died within one year after reconstruction. The remaining patients were ambulated.DiscussionLarge defects of the foot can be treated by free microvascular myocutaneous or fasciocutaneous tissue transfer. If however, small defects, exposing bones or tendons, are not eligible for local flaps, small free microvascular flaps can be applied. These flaps cause a very low donor site morbidity. Arterialized venous flaps are another option for defect closure.Amputation means reduction of quality of life and can lead to an increased mortality postoperatively.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The reconstructed poplito-pedal bypass with the hooked parascapular flap was also visualized. Bypass and flap anastomosis were patent; and the perfusion of the foot was increased [12]. …”

Section: Discussionmentioning

confidence: 99%