Soft-tissue reconstruction for recalcitrant diabetic foot wounds

Cohen, Brenda K.; Zabel, David D.; Newton, E D; Catanzariti, Alan R.

doi:10.1016/s1067-2516(99)80038-6

Cited by 17 publications

(6 citation statements)

References 14 publications

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“…Patients who underwent a free muscle transfer (36) were compared with those who underwent free fasciocutaneous tissue transfer (Cohen, Zabel, Newton, & Catanzariti, 1999) (Tables 1–3). Patient demographics and follow‐up were similar between groups.…”

Section: Resultsmentioning

confidence: 99%

“…Reconstruction in this area must adequately withstand friction and shearing forces from shoe wear and maintain a low profile. The medial plantar artery flap is commonly used for small wounds of the heel pad and ankle (Cohen et al, 1999; Duman et al, 2002; Gu et al, 2017; Khai Luen & Wan Sulaiman, 2017; Oh, Moon, Cha, Koh, & Chung, 2011; Scaglioni, Rittirsch, & Giovanoli, 2018; Schwarz & Negrini, 2006; Siddiqi, Hafeez, Cheema, & Rashid, 2012). For slightly larger or proximal defects, the reverse sural flap or propeller flaps are options (Benito‐Ruiz, Yoon, Guisantes‐Pintos, Monner, & Serra‐Renom, 2004; El‐Shazly & Yassin, 2006; Lu, Chai, Wang, & Wen, 2014; Maffi, Knoetgen III, Turner, & Moran, 2005; Xu & Lai‐Jin, 2008).…”

Section: Discussionmentioning

confidence: 99%

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Long‐term clinical and patient‐reported outcomes in free flap reconstruction of the weight‐bearing heel pad and non‐weight‐bearing Achilles tendon regions

et al. 2020

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Background The non‐weight‐bearing (NWB) Achilles tendon and weight‐bearing (WB) heel pad regions are technically challenging to reconstruct with distinct functional and aesthetic considerations that have not been previously considered in the literature. This study is the first to characterize the long‐term clinical and patient‐reported outcomes of these components to better inform patients about the postreconstruction period. Methods A retrospective review of medical records and phone‐based survey of adult patients who underwent free flap reconstruction of the heel/ankle with 6‐month minimum clinical follow‐up was performed. Results Forty‐three patients, with 31 (72.1%) NWB and 12 (27.9%) WB defects, treated from January 1, 2000 to February 28, 2017 were included. Muscle flaps were more common than fasciocutaneous flaps (N = 36 [83.7%] vs. 7 [16.3%]). Flap survival rate was 95.3% and limb salvage rate was 93.0% at median follow‐up of 12.0 months (interquartile range [IQR] 6.2, 25.5). Flap ulceration occurred more frequently in the WB region (41.7 vs. 6.5%, p = .0123). The survey response rate was 63.6%. The majority of patients complete daily tasks with no/little impairment (76.2%), walk half a mile or more (85.7%), returned to work (86.6%), and fit shoes “fair” or “well” (71.4%). Most patients were “very satisfied” with heel/ankle function (71.4%) and would “very likely” undergo the same procedure if needed (76.2%). Conclusions Free flap reconstruction in both the NWB Achilles tendon and WB heel pad has excellent limb salvage and flap survival rates. Patients were satisfied with heel/ankle function, but additional counseling is recommended for variance in appearance and higher ulceration rates in WB defects.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long‐term clinical and patient‐reported outcomes in free flap reconstruction of the weight‐bearing heel pad and non‐weight‐bearing Achilles tendon regions

et al. 2020

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“…Three articles applied STSG over a (gracilis muscle) free flap or subcutaneous flap [21–23]. Two articles utilized STSG on top of a donor site to an advanced plastic technique: reverse sural artery flap and medial plantar artery flap [24, 25]. The last two employed STSG to heal a partially closed wound treated with another modality or to help close a burn site [26, 27].…”

Section: Resultsmentioning

confidence: 99%

The Use of Split-Thickness Skin Grafts on Diabetic Foot Ulcerations: A Literature Review

McCartan

Dinh

2012

Plastic Surgery International

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Diabetic foot ulcerations are historically difficult to treat despite advanced therapeutic modalities. There are numerous modalities described in the literature ranging from noninvasive topical wound care to more invasive surgical procedures such as primary closure, skin flaps, and skin grafting. While skin grafting provides faster time to closure with a single treatment compared to traditional topical wound treatments, the potential risks of donor site morbidity and poor wound healing unique to the diabetic state have been cited as a contraindication to its widespread use. In order to garner clarity on this issue, a literature review was undertaken on the use of split-thickness skin grafts on diabetic foot ulcers. Search of electronic databases yielded four studies that reported split-thickness skin grafts as definitive means of closure. In addition, several other studies employed split-thickness skin grafts as an adjunct to a treatment that was only partially successful or used to fill in the donor site of another plastic surgery technique. When used as the primary closure on optimized diabetic foot ulcerations, split-thickness skin grafts are 78% successful at closing 90% of the wound by eight weeks.

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“…The most versatile fasciocutaneous flap of the foot is the medial plantar flap, which is the ideal tissue for the coverage of plantar defects. [53][54][55] It can also reach medial ankle defects. It can be harvested to a size as large as 6 Â 10 cm, has sensibility, and has a wide arc of rotation if it is taken with the proximal part of the medial plantar artery.…”

Section: Pedicled Flaps Of the Foot And Anklementioning

confidence: 99%

Functional Reconstruction of the Diabetic Foot

Clemens

Attinger

2010

Seminars in Plastic Surgery

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The diabetic triad of neuropathy, vasculopathy, and foot deformity can be surgically challenging to the reconstructive surgeon. Soft tissue deficits must be closed to protect underlying structures from infection and to provide a stable environment for healing. It is critical to have adequate blood flow and to debride the wound to clean healthy tissue before considering reconstruction. Surgical options commonly used include healing by secondary intention, local flap closure, skin grafts, pedicled flaps, and free tissue transfer. Despite a surgeon's best operative efforts, these strategies may fail perioperatively due to postoperative shear forces created by premature joint motion and/or pressure (either weight bearing or decubitus). In the properly selected patient population, external fixators serve as an indispensable adjunct to wound healing in the Charcot foot by providing temporary but reliable offloading and/or immobilization of joints. Using a team approach is critical to the success of diabetic limb reconstruction.

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Soft-tissue reconstruction for recalcitrant diabetic foot wounds

Cited by 17 publications

References 14 publications

Long‐term clinical and patient‐reported outcomes in free flap reconstruction of the weight‐bearing heel pad and non‐weight‐bearing Achilles tendon regions

Long‐term clinical and patient‐reported outcomes in free flap reconstruction of the weight‐bearing heel pad and non‐weight‐bearing Achilles tendon regions

The Use of Split-Thickness Skin Grafts on Diabetic Foot Ulcerations: A Literature Review

Functional Reconstruction of the Diabetic Foot

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