Soft Tissue Reconstruction with Diabetic Foot Tissue Loss

Hasenstein, Todd; Greene, Timothy; Van, Jennifer C.; Meyr, Andrew J.

doi:10.1016/j.cpm.2019.02.006

Cited by 6 publications

(5 citation statements)

References 34 publications

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“…3,4 Surgical procedures may also be considered, including muscle or muscle-cutaneous flaps, but these are not always suitable. 5 Additional therapeutic options come from regenerative medicine with the availability of dermal and epidermal substitutes (DESs). 6 Specific experiences in DF care have been reported.…”

Section: Introductionmentioning

confidence: 99%

Use of Nevelia Dermal-Epidermal Regenerative Template in the Management of Ischemic Diabetic Foot Postsurgical Wounds

Uccioli

Meloni

Izzo

et al. 2020

The International Journal of Lower Extremity Wounds

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The purpose of this cross-sectional study is evaluate the effectiveness of a dermal-epidermal substitute (DES) composed of 3-dimensional porous matrix of type 1, purified, stabilized, bovin-origin collagen (Nevelia, SYMATESE, Chaponost, France) without a subsequent skin graft in the treatment ischemic postsurgical diabetic foot ulcers. This study group was composed of a sample of consecutive diabetic patients with critical limb ischemia and postsurgical wounds. All patients received a preset limb salvage protocol including the application of the DES, but none received a skin graft. Patients were closely followed until wound healing or different outcome. The outcome measures were healing, nonhealing, major amputation, and death evaluated at 1 and 2 years of follow-up. Forty-one patients were included. The average postsurgical wound area was 69.6 ± 50 cm2. Twenty-one patients (51%) healed; 10 patients (24%) did not heal after 1 year of follow-up; however, all of them achieved a mean ulcer size reduction >50%; 7 patients (17%) were amputees; 3 patients (7.3%) died. In a later follow-up (2 years), wounds in 8 additional patients healed. Successful revascularization was an independent predictor of healing (hazard ratio = 5.1, 95% confidence interval [CI] = 2.5-14-9; P = .0001), the postsurgical ulcer size (>50 cm2) was an independent predictor of nonhealing (hazard ratio = 6.2, 95% CI = 2.1-38.4; P = .0001) while recurrence of critical limb ischemia was an independent predictor of major amputation (odds ratio = 3.4, 95% CI = 1.1-4.5; P = .002). The DES composed of type 1 bovin-origin collagen is useful in the treatment of large postsurgical diabetic foot ulcers, even when the skin graft is not a suitable therapeutic option.

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Section: Introductionmentioning

confidence: 99%

Use of Nevelia Dermal-Epidermal Regenerative Template in the Management of Ischemic Diabetic Foot Postsurgical Wounds

Uccioli

Meloni

Izzo

et al. 2020

The International Journal of Lower Extremity Wounds

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“…8 Technologies like dermal grafts, negative pressure, and bone substitutes give a better chance to achieve healing also in severely compromised patients. 9…”

Section: Introductionmentioning

confidence: 99%

Pilot Experience on the Use of S53P4 Bioactive Glass in the Surgical Management of Diabetic Foot Osteomyelitis

Iacopi

Pieruzzi

Goretti

et al. 2020

The International Journal of Lower Extremity Wounds

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To test safety and efficacy of bioactive glass, a novel material used to replace bone, able to completely bond itself to the host tissues on patients treated for osteomyelitis (OM) complicating a diabetic foot (DF). We evaluated a group of patients consecutively admitted in our department between September and December 2018, who underwent surgical DF procedures for OM and in whom the use of bioactive glass could limit the demolition phase of surgical procedure. Patients were treated with bioactive glass S53P4 on top of standard treatment directly in operating room. The patients were weekly controlled for 6 months or until complete healing. During follow-up, we analyzed primarily healing rate and secondarily time of healing, need for further debridement procedures, recurrences, and adverse or hypersensitivity reactions to study treatment. Ten DF patients were enrolled (male/female 6/4; mean age 56 ± 11 years; mean duration of diabetes 10.5 ± 4.7 years, mean hemoglobin A1c 7.2 ± 0.9%). Patients underwent surgical procedure during which, after an accurate debridement, bioactive glass was applied. A healing rate of 80% in a mean time of 34 ± 2 days, with only 1 patient who needed a second surgical look, was observed. Neither recurrences nor adverse events during follow-up were observed in treated patients. This pilot experience demonstrated that bioactive glass can be considered a useful tool for the surgical treatment of DF-related OM.

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“…6,7 The reconstructive ladder, first described by Mathes and Nahai in 1982, serves as a cornerstone in determining the optimal management strategy for complex wounds. 8,9 The ladder describes a step-wise, linear approach to the closure of complex wounds beginning with basic, local wound care and escalating to the utilization of local rotational flaps, pedicled flaps, and free flaps. 8 However, as techniques have improved and a multidisciplinary approach has been adopted, the reconstructive ladder has been transformed into the reconstructive elevator.…”

mentioning

confidence: 99%

“…8,9 The ladder describes a step-wise, linear approach to the closure of complex wounds beginning with basic, local wound care and escalating to the utilization of local rotational flaps, pedicled flaps, and free flaps. 8 However, as techniques have improved and a multidisciplinary approach has been adopted, the reconstructive ladder has been transformed into the reconstructive elevator. In this model, physicians may jump ahead to the treatment most likely to be effective in a given situation, rather than failing multiple steps before reaching definitive management.…”

mentioning

confidence: 99%

“…In this model, physicians may jump ahead to the treatment most likely to be effective in a given situation, rather than failing multiple steps before reaching definitive management. 8,10 The lower rungs of the ladder, which include primary closure and skin grafting, are often inadequate for reconstruction of LE chronic wounds due to insufficient healthy tissue and biomechanical stress from ambulation. 11 Because of this, there has been a growing focus on achieving limb salvage by using local and free flaps, both of which are excellent options for LE reconstruction in diabetic patients with complex wounds.…”

mentioning

confidence: 99%

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The Need to Improve Patient-Centered Outcome Reporting Following Lower Extremity Flap Reconstruction: A Systematic Review and Meta-analysis

Kim

Tirrell

Dekker

et al. 2021

J Reconstr Microsurg

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Introduction Research in lower extremity (LE) wound management involving flap reconstruction has primarily focused on surgeon-driven metrics. There has been a paucity in research that evaluates patient-centered outcomes (PCO). This systematic review and meta-analysis examines articles published between 2012 and 2020 to assess whether reporting of functional and quality of life (QOL) outcomes have increased in frequency and cohesiveness, compared with the previous two decades. Methods PubMed and Ovid were queried with appropriate Medical Subject Heading (MeSH) terms for studies published between June 2012 and July 2020. For inclusion, each study had to report any outcome of any tissue transfer procedure to the LE in comorbid patients, including complication rates, ambulation rates, flap success rates, and/or QOL measures. The PCO reporting prevalence was compared with a previous systematic review by Economides et al which analyzed papers published between 1990 and June 2012, using a Pearson's Chi-squared test. Results The literature search yielded 40 articles for inclusion. The proportion of studies reporting PCO was greater for literature published between 1990 and 2012 compared with literature published between 2012 and 2020 (86.0 vs. 50.0%, p < 0.001). Functional outcomes were more commonly reported between 1990 and 2012 (78.0 vs. 47.5%, p = 0.003); similarly, ambulatory status was reported more often in the previous review (70.0 vs. 40.0%, p = 0.004). This study solely examined the rate at which PCO were reported in the literature; the individual importance and effect on medical outcomes of each PCO was not evaluated. Conclusion Less than 50% of the literature report functional outcomes in comorbid patients undergoing LE flap reconstruction. Surprisingly, PCO reporting has seen a downward trend in the past 8 years relative to the preceding two decades. Standardized inclusion of PCO in research regarding this patient population should be established, especially as health care and governmental priorities shift toward patient-centered care.

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Soft Tissue Reconstruction with Diabetic Foot Tissue Loss

Cited by 6 publications

References 34 publications

Use of Nevelia Dermal-Epidermal Regenerative Template in the Management of Ischemic Diabetic Foot Postsurgical Wounds

Use of Nevelia Dermal-Epidermal Regenerative Template in the Management of Ischemic Diabetic Foot Postsurgical Wounds

Pilot Experience on the Use of S53P4 Bioactive Glass in the Surgical Management of Diabetic Foot Osteomyelitis

The Need to Improve Patient-Centered Outcome Reporting Following Lower Extremity Flap Reconstruction: A Systematic Review and Meta-analysis

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