title: Square, Random Fasciocutaneous Plantar Flaps for Treating Noninfected Diabetic Plantar Ulcers: A Patient Series.
abstract: In patients with diabetes, the off-loading cast has not been widely used to treat plantar ulcers because of its poor acceptance by patients and the high risk of side effects. We evaluated the safety and efficacy of an alternative surgical treatment: a square, fasciocutaneous random plantar flap to cover plantar ulcers. From December 2012 to February 2013, we enrolled 23 consecutive diabetic patients with deep neuropathic or neuroischemic plantar ulcers. Of these 23 patients, 9 underwent percutaneous transluminal angioplasty, 10 had the metatarsal removed, 3 underwent dorsiflexory, distal metatarsal osteotomies, 2 underwent first metatarsophalangeal joint resection and ray stabilization with Kirschner wires, and 1 each underwent midfoot exostectomy, sesamoidectomy, and partial calcanectomy. A square random fasciocutaneous plantar flap was created for all 23 patients. Two patients were excluded from the analysis for weightbearing on the involved foot within 24 hours of surgery. The healing rate was 100% for the remaining 21 patients, with healing by first intention in 15 (mean ± standard deviation time to healing 30 ± 13 days), by second intention in 5 (86 ± 40 days), and by surgical revision in 1. The overall mean healing time was 44 ± 31 days. During a mean follow-up of 724 ± 275 days, no ulcer recurred; however, 1 transfer ulcer appeared on an adjacent metatarsal head. The use of a square random fasciocutaneous plantar flap is a safe and effective surgical option for treating neuropathic plantar ulcers, offering a high healing rate, a short healing time, and a low rate of recurrence.
authors.affiliation: Professor, Diabetic Foot Department, Istituto Clinico Città Studi, Milan, Italy. Electronic address: caravaggi@me.com.
authors.forename: Carlo Maria Ferdinando
authors.initials: CM
authors.lastname: Caravaggi
authors.affiliation: Emergent Surgeon, Diabetic Foot Department, Istituto Clinico Città Studi, Milan, Italy.
authors.forename: Adriana Barbara
authors.initials: AB
authors.lastname: Sganzaroli
authors.affiliation: Plastic Surgeon, Diabetic Foot Department, Istituto Clinico Città Studi, Milan, Italy.
authors.forename: Fosca
authors.initials: F
authors.lastname: Bona
authors.affiliation: Diabetologist, Diabetic Foot Department, Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Galenda
authors.affiliation: Interventional Cardiologist, Interventional Cardiovascular Unit, Humanitas Gavazzeni, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferraresi
authors.affiliation: Plastic Surgeon, Plastic Surgery Division, Istituto Clinico Città Studi, Milan, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Gherardi
authors.affiliation: Plastic Surgeon, Plastic Surgery Division, Istituto Clinico Città Studi, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Reho
mesh_terms: D000368:Aged; D015331:Cohort Studies; D000072226:Computed Tomography Angiography / Q000379:methods; D017719:Diabetic Foot / Q000175:diagnosis / Q000523:psychology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000098:blood supply / Q000637:transplantation*; D000069262:Plantar Plate / Q000601:surgery; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*
keywords: diabetic foot; fasciocutaneous flap; neuroischemic ulcer; neuropathic ulcer; total contact cast