title: A systematic review of free tissue transfer in the management of non-traumatic lower extremity wounds in patients with diabetes.
abstract: OBJECTIVE
  Wounds of the lower limb in patients with diabetes are frequently difficult to heal. Some wounds fail to heal despite optimal medical and surgical care. This review examines the evidence for whether free tissue transfer techniques may reduce the requirement of amputation in these patients.
  
  
  METHODS
  A systematic review.
  
  
  METHODS
  Pubmed, Embase, AMED, SCOPUS and CINAHL and Cochrane Library were searched for all articles on free tissue transfer in lower limb wounds in patients with diabetes (September 2010). Current experience, indications and outcomes were analysed.
  
  
  RESULTS
  528 patients from 18 studies were included in the systematic review. 66% of patients had concomitant revascularisation with bypass surgery. 63% of flaps were muscle based, 35% fasciocutaneous and 1.7% omental. Pooled in-hospital mortality rate was 4.4%, flap survival was 92% and limb salvage rate of 83.4% over a 28 months average follow-up time.
  
  
  CONCLUSIONS
  In conclusion free tissue transfer achieves successful wound healing in selected patients with diabetes and difficult to heal wounds that would have required amputation. Pre-operative optimisation of vascular supply and eradication of infection is key to success. Objective wound assessment scores and a clear multidisciplinary team (MDT) approach would improve patient care.
authors.affiliation: St George's Vascular Institute, St Georges Healthcare NHS Trust, London, UK.
authors.forename: E J
authors.initials: EJ
authors.lastname: Fitzgerald O'Connor
authors.forename: M
authors.initials: M
authors.lastname: Vesely
authors.forename: P J
authors.initials: PJ
authors.lastname: Holt
authors.forename: K G
authors.initials: KG
authors.lastname: Jones
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
authors.forename: R J
authors.initials: RJ
authors.lastname: Hinchliffe
mesh_terms: D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical; D017719:Diabetic Foot / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013524:Surgical Flaps / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D014945:Wound Healing; D055815:Young Adult