Use of Local Flaps for Soft-Tissue Closure in Diabetic Foot Wounds: A Systematic Review

Abstract

“A systematic review was undertaken to assess the outcomes of local random flaps in diabetic foot wound closure. The review was conducted using the following databases: Cumulative Index of Nursing and Allied Health Literature, Cochrane Library, Excerpta Medica dataBASE, Google Scholar, MEDLINE, Ovid, and PubMed. Search terms were local random flap, diabetes, foot, wound, ulceration, neuropathy, tissue transfer, V-Y, bilobed, monolobed, rotational, advancement, transpositional, rhomboid, and Limberg. English language studies, studies published from 1997 to 2017, patients with diabetes mellitus treated for foot wounds, use of local random flaps, follow-up period of 6 months or more postoperatively, documentation of healing rates, complications, and need for revisional surgery were included. Isolated literature reviews and descriptions of only surgical technique and/or cadaveric studies were excluded. The initial search identified 53 eligible studies with 28 being excluded. The remaining 25 studies used for data extraction had a total of 512 patients in which 199 of these underwent 204 local random flap procedures. Average follow-up for the flaps was approximately >2 years, and successful wound closure at last follow-up was demonstrated in 75.5% of the studied population. Studies were found to be of generally low quality, with the majority composed of retrospective case series. Based on current available evidence found in this systematic review, local random flaps demonstrated a relatively high success rate when utilized for the definitive closure of diabetic foot wounds. However, because of a lack of high-quality evidence and substantial heterogeneity among the studies, the results should be interpreted with caution. Levels of Evidence: Level III: Systematic review

Reconstruction of Plantar Forefoot in Diabetic Foot Ulcers: A Comparative Study of Perforator Flaps and Random Flaps

“…In addition, the surgery leaves no donor site morbidity, and also has the advantage of tissue similarity because the defect area can be replaced with adjacent tissue (Fig. 1) [10].…”

Nose reconstruction using local and regional flaps: The challenges and advantages

“…So it can be used on defects on the lateral side. [ 15 16 17 ] This flap is known for its best cosmetic results, but the donor site is limited and hence used for small defects only. [ 18 19 ] In our study, the lateral defects of two patients were covered using bilobed flaps, both of them had excellent cosmetic results and minimal or no donor-site morbidity [ Figure 3A–C ].…”

Combined Use of Autologous Stromal Vascular Fraction Cells and Platelet-Rich Plasma for Chronic Ulceration of the Diabetic Lower Limb Improves Wound Healing

“…The treatment of recalcitrant CDU of the lower limb can be quite a long and challenging process. 7,14,15 Patients with diabetes are often accompanied by peripheral neuropathy, peripheral vascular disease, and multiple medical comorbidities, 7 which can block the natural repair process of the human body and leave the wound unhealed for a long time. Current standard management consists of surgical debridement, dressings promoting a moist wound environment, wound off-loading, vascular assessment, treatment of active infection, glycemic control, autologous skin grafting, and even skin flap transfer.…”

“…Current standard management consists of surgical debridement, dressings promoting a moist wound environment, wound off-loading, vascular assessment, treatment of active infection, glycemic control, autologous skin grafting, and even skin flap transfer. 7,[16][17][18][19] However, the healing rate is low with a high mortality and amputation rate. 15,20 In recent years, the application of SVFs and PRP in tissue regeneration and wound therapy has attracted increasing attention and inspired new ideas for the treatment of recalcitrant CDU of the diabetic lower limb.…”

“…In addition, CDUs are often accompanied by complications such as recurrence of wound and poor healing of the donor site incision. 7,8 Therefore, the exploration of novel surgical therapeutic strategies for CDU is quite urgent.…”