title: Combined reconstruction of the diabetic foot including revascularization and free-tissue transfer.
abstract: Diabetic patients, presenting with both peripheral vascular disease and large soft-tissue defects, are too often treated by primary amputation. A combined revascularization and free-tissue transfer procedure can extend limb salvage in these patients. The authors report their experience over 4 years with 19 diabetic patients with peripheral vascular disease and large soft-tissue defects of the foot requiring free-tissue transfer. Although there was a 100 percent flap survival, early local wound problems occurred in three patients (16.6 percent). The recurrence rate was about 18.7 percent, but no complementary flap procedures were mandatory. With a mean follow-up of 38 months (range: 23 to 55 months), the limb salvage rate was 94.4 percent. Although there was one limb loss and one patient with ambulation difficulties, 16 patients (84.2 percent) were fully rehabilitated and were able to function independently. Despite a rather small series, this study confirms that in selected diabetic patients, a combined approach of vascular and reconstructive surgeons can reduce the limb amputation rate with acceptable complication rates. This combined approach offers major benefits to these patients, especially stable coverage and preservation of ambulation, and should always be considered before amputation.
authors.affiliation: Department of Maxillofacial, Hand, and Plastic and Reconstructive Surgery, CHU Sart Tilman, University of Liège, Belgium.
authors.forename: N A C
authors.initials: NA
authors.lastname: Verhelle
authors.forename: V
authors.initials: V
authors.lastname: Lemaire
authors.forename: X
authors.initials: X
authors.lastname: Nelissen
authors.forename: H
authors.initials: H
authors.lastname: Vandamme
authors.forename: O
authors.initials: O
authors.lastname: Heymans
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D001807:Blood Vessel Prosthesis; D015331:Cohort Studies; D003646:Debridement; D003925:Diabetic Angiopathies / Q000601:surgery*; D017719:Diabetic Foot / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005500:Follow-Up Studies; D005528:Foot / Q000098:blood supply*; D006085:Graft Survival; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D011150:Popliteal Artery / Q000601:surgery; D012008:Recurrence; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome