Successful foot salvage with microvascular flaps in diabetic patients.
OBJECTIVE
Complex nontraumatic foot lesions often lead to major lower-limb amputation in diabetic patients. We aimed to evaluate outcome of free flap transfer in such cases.


METHODS
A total of 11 consecutive diabetic patients, hospitalized between 2007 and 2012 at a university central hospital for a free flap transfer, were followed until September 2013. Amputation-free survival, patient survival, and complete wound healing were defined as primary endpoints. Healing time of tissue lesions was analyzed. All pre- and postoperative data were retrospectively collected from hospital charts.


RESULTS
Complete tissue healing at 6 and 12 months after free flap transfer were 55% (6/11) and 82% (9/11), respectively. The median time to complete tissue healing was 123 days (range, 45-207 days). Overall limb salvage, survival, and amputation-free survival rates at 12 months were 90%, 91%, and 82%, respectively. The clinically important endpoint, namely, amputation-free survival with completely healed wounds, was attained in 9 of 11 patients at 1 year.


CONCLUSIONS
Free tissue transfer enables successful wound healing and limb salvage rather than amputation in selected diabetic patients with difficult-to-heal wounds. Complete healing of tissue lesions is slow even after successful surgery. Preoperative assessment of the condition of patients is the key to success.
Department of Plastic Surgery, Tampere University Hospital, Tampere, Finland elina.eskelinen@pshp.fi.
E
E
Eskelinen
Department of Plastic Surgery, Tampere University Hospital, Tampere, Finland.
I
I
Kaartinen
Department of Plastic Surgery, Tampere University Hospital, Tampere, Finland.
M
M
Kääriäinen
Department of Plastic Surgery, Tampere University Hospital, Tampere, Finland.
H
H
Kuokkanen
D000328:Adult; D000368:Aged; D005260:Female; D005387:Finland / Q000453:epidemiology; D016523:Foot Ulcer / Q000401:mortality / Q000601:surgery*; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D015994:Incidence; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
Free tissue transfer; amputation-free survival with healing; diabetic foot; limb salvage; tissue healing; ulcer healing