title: Retrospective review of free gracilis muscle flaps in the management of nonhealing diabetic foot ulceration.
abstract: This study retrospectively examined data from 45 patients with diabetic foot ulcers who underwent free gracilis muscle reconstruction from January 1999 to December 2003. Twenty-five patients (55.6%) were men and 20 (44.4%) were women. The mean age was 60.2 years (range, 34-90 years). The mean follow-up was 27 months (range, 6-36 months). The lesions were located on the dorsum of the foot (38.5%), hallux (18.5%), and the fifth toe (12.3%). According to Wagner's classification, 28% of the ulcers were grade 2, 20% were grade 3, and 51.1% were grade 4. Initial management of these patients included control of blood sugar level, proper hydration, administration of antibiotics, treatment of coexisting diseases, and repeated debridements of wounds when necessary. A total of 48 gracilis muscle flaps were harvested for reconstruction. There were 35 (72.9%) patients with complete success when there was complete healing of the flap; 12 patients with partial success when there was some loss of the flap or skin graft, or draining wounds; and 1 patient (2.1%) with failure. There was no infection or hematoma of the flap donor site; only hypertrophic scarring occurred in 3 patients (6.6%). The free gracilis muscle flap is a safe, simple, and effective method for coverage of difficult diabetic foot ulcers. Its use results in good aesthetic and functional outcome and low donor site morbidity.
authors.affiliation: Burns and Plastic Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Nigeria. osiogofelix@yahoo.com
authors.forename: Felix Omonosioni
authors.initials: FO
authors.lastname: Osiogo
authors.forename: Chung-Sheng
authors.initials: CS
authors.lastname: Lai
authors.forename: Wen-Her
authors.initials: WH
authors.lastname: Wang
authors.forename: Yoong-Foo
authors.initials: YF
authors.lastname: Chye
authors.forename: Sin-Daw
authors.initials: SD
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017719:Diabetic Foot / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D012189:Retrospective Studies; D013524:Surgical Flaps; D014945:Wound Healing