title: Limb salvage and vascular augmentation by microsurgical free flap transfer for treatment of neuropathic diabetic foot ulcers.
abstract: BACKGROUND
  Neuropathic diabetic foot ulcers are generally deep and infectious wounds extending to the bone or joint. We performed microsurgical free flap transfer for limb salvage and vascular augmentation of feet with diabetic neuropathy.
  
  
  METHODS
  Angiography was performed to identify any significant arterial disease. The free flaps were transplanted after resection of the damaged skin and infected bone. Flow-through or end-to-side anastomosis to the dorsalis pedis artery was performed to preserve the arterial blood flow to the residual foot.
  
  
  RESULTS
  An anterolateral thigh flap and free flaps based on the subscapular artery system were transplanted in 1 and 10 patients, respectively. All flaps survived. Arterial flow on the distal side of the anastomosis was postoperatively confirmed in all patients. During a mean follow-up period of 52 months, the long-term complications observed were recurrent ulcers in 4 patients. The limb salvage rate was 100%, and 82% of patients achieved functional ambulation.
  
  
  CONCLUSIONS
  Microsurgical flap transplantation is a safe and useful technique for minimal amputation of a diabetic neuropathic foot. Postoperative protection of the feet is important in order to avoid recurrence of foot ulceration. The use of protective footwear custom-tailored for each patient is strongly recommended.
authors.affiliation: Department of Plastic and Reconstructive Surgery, the University of Tokushima Graduate School.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Hashimoto
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Abe
authors.forename: Atsushi
authors.initials: A
authors.lastname: Morimoto
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kashiwagi
authors.forename: Keiichi
authors.initials: K
authors.lastname: Goishi
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakanishi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017719:Diabetic Foot / Q000601:surgery*; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures