A New Approach for Reconstruction of Diabetic Foot Wounds Using the Angiosome and Supermicrosurgery Concept.
BACKGROUND
Major vessels in the diabetic foot are often calcified and inadequate for use as recipient vessels. Thus, a supermicrosurgery technique using small branches or perforators from other collateral vessels with an adequate pulse may be an alternative method. This study evaluated outcome using the supermicrosurgery concept and the risk factors involved.


METHODS
Ninety-five cases of diabetic foot reconstruction were reviewed; the average patient age was 57 years; average follow-up was 43.5 months. Débridement was performed according to the angiosome concept, and reconstruction was performed with perforator flaps using the supermicrosurgery approach. Correlation between total flap loss and 16 preoperative risk factors (age, sex, diabetes mellitus type, smoking, immunosuppression, flap size, hemoglobin A1c, ankle-brachial index, preoperative transcutaneous partial pressure of oxygen, C-reactive protein, computed tomographic angiography, amputation history, peripheral artery disease, American Society of Anesthesiologists physical status, osteomyelitis, and chronic renal failure) were analyzed.


RESULTS
Of 95 cases, nine cases of total loss and 12 of minor complication were noted. Among the risk factors, the odds for failure after peripheral artery disease was 10.99 (p = 0.035), and that associated with a history of amputation was 9.44 (0.0006). Other factors had no correlation with flap loss, including cases with no or one major vessel. Flap survival rate was 90.5 percent, and the overall limb salvage rate was 93.7 percent.


CONCLUSIONS
Despite the high risk of failure related to peripheral artery disease and history of amputation, the supermicrosurgery approach using a recipient vessel with good pulsation regardless of the source can achieve limb salvage. This approach extends the possibility for reconstruction in patients with severe ischemic diabetic foot.


METHODS
Therapeutic, IV.
Seoul, Republic of Korea.|From the Departments of Plastic and Reconstructive Surgery, Orthopedic Surgery, Cardiology, Vascular Surgery, and Endocrinology, Asan Medical Center, University of Ulsan Collage of Medicine.
Hyun Suk
HS
Suh
Seoul, Republic of Korea.|From the Departments of Plastic and Reconstructive Surgery, Orthopedic Surgery, Cardiology, Vascular Surgery, and Endocrinology, Asan Medical Center, University of Ulsan Collage of Medicine.
Tae Suk
TS
Oh
Seoul, Republic of Korea.|From the Departments of Plastic and Reconstructive Surgery, Orthopedic Surgery, Cardiology, Vascular Surgery, and Endocrinology, Asan Medical Center, University of Ulsan Collage of Medicine.
Ho Seung
HS
Lee
Seoul, Republic of Korea.|From the Departments of Plastic and Reconstructive Surgery, Orthopedic Surgery, Cardiology, Vascular Surgery, and Endocrinology, Asan Medical Center, University of Ulsan Collage of Medicine.
Seung Hwan
SH
Lee
Seoul, Republic of Korea.|From the Departments of Plastic and Reconstructive Surgery, Orthopedic Surgery, Cardiology, Vascular Surgery, and Endocrinology, Asan Medical Center, University of Ulsan Collage of Medicine.
Yong Pil
YP
Cho
Seoul, Republic of Korea.|From the Departments of Plastic and Reconstructive Surgery, Orthopedic Surgery, Cardiology, Vascular Surgery, and Endocrinology, Asan Medical Center, University of Ulsan Collage of Medicine.
Joong Ryul
JR
Park
Seoul, Republic of Korea.|From the Departments of Plastic and Reconstructive Surgery, Orthopedic Surgery, Cardiology, Vascular Surgery, and Endocrinology, Asan Medical Center, University of Ulsan Collage of Medicine.
Joon Pio
JP
Hong
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003097:Collateral Circulation; D003646:Debridement / Q000379:methods; D017719:Diabetic Foot / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation*; D006085:Graft Survival; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D061525:Perforator Flap / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome
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