Limb Salvage and Functional Outcomes following Free Tissue Transfer for the Treatment of Recalcitrant Diabetic Foot Ulcers

Lu, Jocelyn; DeFazio, Michael V.; Lakhiani, Chrisovalantis; Abboud, Michel; Penzler, Morgan M; Elmarsafi, Tammer; Kim, Paul J.; Attinger, Christopher E.; Evans, Karen K.

doi:10.1055/s-0038-1667363

Cited by 36 publications

(36 citation statements)

References 24 publications

(27 reference statements)

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“…Despite the challenges in diabetic foot reconstruction, with multidisciplinary approach and reconstruction, the flap success rate along with limb salvage rate can be from 80 to 90%. [1][2][3][4]12,16,17 But during our experience, we noticed a higher rate for failure in the heel while other parts of the foot had similar rate of success. Knowing that heel ulcers may lead to higher rate of amputation when healing is delayed and thus recognizing the importance of heel reconstruction, we decided to take a closer look into the overall outcome and the factors involved.…”

Section: Discussionmentioning

confidence: 90%

Reconstruction Using Free Flaps for Diabetic Heel Defects: Outcomes and Risk Factor Analysis

Kim

Altiparmak

Pak

et al. 2020

J Reconstr Microsurg

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Background Overall success rate after diabetic foot reconstruction using free flap has been acceptable, but certain parts of the foot like the heel remains more challenging. Patients and Methods This retrospective study reviewed 37 patients reconstructed with free flaps for diabetic foot ulcer on the heel region from 2008 to 2017. Flap outcome in addition to various risk factors were analyzed; arterial status on heel, the American Society of Anesthesiologists (ASA) physical status, smoking, hypertension, hypercholesterolemia, chronic renal failure patient, hemoglobin A1c level, C-reactive protein, and osteomyelitis. Results Overall flap survival was 73% and resulted in limb salvage and functional ambulation. Total flap loss was 27% and the majority ended up with high-level amputation. Among the risk factors evaluated, the arterial status of the heel and ASA status significantly increased the odds for failure. When both arterial branches to the heel were impaired, the odds of failure were 80 times higher to fail (p< 0.05). Conclusion The vascularity of the surrounding tissue of the defect plays a critical role in overall success of diabetic heel reconstruction. Aggressive debridement using the angiosome concept is necessary to assure surrounding tissue has a good circulation. Despite the high chance of failure, success will lead to limb salvage and to reasonable functional ambulation whereas failure to salvage the heel will lead to higher level amputation. This warrants microsurgeons to make an effort to perform reconstruction to the heel defect after obtaining maximal vascularity after angioplasty.

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Section: Discussionmentioning

confidence: 90%

Reconstruction Using Free Flaps for Diabetic Heel Defects: Outcomes and Risk Factor Analysis

Kim

Altiparmak

Pak

et al. 2020

J Reconstr Microsurg

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“…institution recently published the first dedicated functional assessment of microsurgical diabetic limb salvage (DLS). 119 In 29 patients with diabetes mellitus (diabetes mellitus [DM]), 93% flap success and 76% limb salvage was reported. In an earlier study, lower extremity functional score (LEFS) testing indicated patients who required BKA achieved "limited community ambulation" classification compared with those who underwent successful reconstruction, who were classified as "independent community ambulators."…”

Section: Amputation Versus Reconstructionmentioning

confidence: 99%

Amputations versus Salvage: Reconciling the Differences

Black

Ormiston

Fan

et al. 2019

J Reconstr Microsurg

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Background There are many factors to consider when choosing between amputations versus salvage in lower extremity reconstructive surgery. Postoperative functionality and survival benefit are critical factors when deciding between limb salvage and amputation. Methods In this review, we present the evidence and the risks and benefits between these two options in the setting of the acute, trauma population and the chronic, diabetes population. Results The trauma population is on average young without significant comorbidities and with robust vasculature and core strength for recovery. Therefore, these patients can often recover significant function with anamputation and prosthesis. Amputation can therefore be the more desirable in this patient population, especially in the case of complete traumatic disruption, unstable patients, high risk of extensive infection, and significant nerve injury. However, traumatic lower extremity reconstruction is also a viable option, especially in the case of young patients and those with intact plantar sensation and sufficient available tissue coverage. The diabetic population with lower extremity insult has on average a higher comorbidity profile and often lower core strength. These patients therefore often benefit most from reconstruction to preserve limb length and improve survival. However, amputation may be favored for diabetics that have no blood flow to the lower extremity, recalcitrant infection, high-risk comorbidities that preclude multiple operations, and those with end stage renal disease. Conclusion Many patient-specific factors should be considered when deciding between amputation vs. salvage in the lower extremity reconstruction population.

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“…Additionally, pressure applied to the region reaches out without the patient being taken note of. Wound size likewise assumes a key job in visualization, and this examination found that individuals with UPD> 5 cm in distance across had more regrettable results than those with littler ulcers [21][22]. These discoveries are like the discoveries of another US study that found that risk factors or wound qualities most drastically connected with wound recuperating disappointment expanded the size and length of wound healing [23].…”

Section: Resultsmentioning

confidence: 67%

Study to Determine the Complications and Treatment of Diabetic Foot Ulcer

Shah

Keerio

Khanzada³

et al. 2021

JPRI

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Background: Diabetic foot ulcer is a solitary most costly and severe complication of diabetes mellitus. Foot ulcers are the after-effect of a combination of various causes, counting peripheral arterial disease and peripheral neuropathy. Patients with diabetic foot ulcers for the most part require lower limb amputation. Objective: The purpose of this examination is to survey the outcomes and complications of diabetic foot ulcers in diabetic patients and to explore the impacts of certain hazard factors on ulcer healing. Place and Duration: In the Orthopedic unit, Dow University Of Medical and Health Sciences, SMBBIT Karachi, for nearly a two-year duration from March 2018 to April 2020. Methods: This study was conducted on 120 patients. All patients with diabetes and DFU 18 to 90 of age were selected. 120 grown-up patients with DFUs were selected for the analysis. The diabetes duration and demographic data were recorded. Clinical proof of infection has been accounted for, as indicated by the American Association for Infectious Diseases. At that point debridement and careful treatment were begun to evacuate all the dead tissue. Follow-up was done week by week for two-year. SPSS 22 was utilized for data collection and statistical analysis. Data are introduced as a percentage and p < 0.05 was considered as the significance level. The Fisher’s test and χ2 test were utilized to test the variables relationship. Multivariate logistic regression analysis was utilized to change different variables when testing the impact of each risk factor on the outcome of DFU. Results: A sum of 120 patients with diabetic foot ulcers were selected. 60% of patients had relieved ulcers, 8% still not resolved; In 27% of patients, minimum amputation, 7% more protuberant amputation, 2% repetitive ulcer and mortality rate was 1%. The investigation indicated that there is a measurably noteworthy connection between the foot ulcers healing with diabetes and the accompanying factors: HbA1c level, patients’ age, diabetes duration, diabetes complications (ulcer size and peripheral neuropathy). Conclusion: The outcomes and complications of diabetic foot ulceration can be anticipated by a few factors, some of which can be changed. Changing compatible factors, for example, better diabetes control, peripheral neuropathy treatment and early treatment of ulcers can reduce complications and encourage healing of ulcers.

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Limb Salvage and Functional Outcomes following Free Tissue Transfer for the Treatment of Recalcitrant Diabetic Foot Ulcers

Cited by 36 publications

References 24 publications

Reconstruction Using Free Flaps for Diabetic Heel Defects: Outcomes and Risk Factor Analysis

Reconstruction Using Free Flaps for Diabetic Heel Defects: Outcomes and Risk Factor Analysis

Amputations versus Salvage: Reconciling the Differences

Study to Determine the Complications and Treatment of Diabetic Foot Ulcer

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