title: Free flap reconstruction for diabetic foot limb salvage.
abstract: BACKGROUND
  Although free flap is gaining popularity for the reconstruction of diabetic foot ulcers, it is unclear whether free flap reconstruction increases the chances of postoperative independent ambulation. The aim of this study is to evaluate the relationship between free flap success and postoperative ambulation.
  
  
  METHODS
  This study reviewed 23 cases of free flap reconstruction for diabetic foot ulcers between January 2007 and March 2014. Free rectus abdominis, latissimus dorsi, and anterolateral thigh flaps were used in ten, eight, and five patients, respectively. A comparison was made between free flap success and postoperative independent ambulation using Fisher's exact test.
  
  
  RESULTS
  Two patients developed congestive heart failure with fatal consequences within 14 days postoperatively, resulting in an in-hospital mortality rate of 8.7%. Five patients lost their flaps (21.7%). Of the 16 patients who had flap success, 12 achieved independent ambulation. Five patients with flap loss did not achieve independent ambulation, except one patient who underwent secondary flap reconstruction using a distally based sural flap. Fisher's exact test revealed that independent ambulation was associated with free flap success (p = 0.047).
  
  
  CONCLUSIONS
  The present study indicates that free flap reconstruction may increase the possibility of independent ambulation for patients with extensive tissue defects due to diabetic ulcers. Intermediate limb salvage rates and independent ambulation rates were favourable in patients with successful reconstruction. The use of foot orthoses and a team approach with pedorthists were effective to prevent recurrence.
authors.affiliation: a Department of Plastic and Reconstructive Surgery , Saitama Medical University , Moroyama, Iruma-gun , Saitama , Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Sato
authors.affiliation: a Department of Plastic and Reconstructive Surgery , Saitama Medical University , Moroyama, Iruma-gun , Saitama , Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yana
authors.affiliation: a Department of Plastic and Reconstructive Surgery , Saitama Medical University , Moroyama, Iruma-gun , Saitama , Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Ichioka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003646:Debridement; D017719:Diabetic Foot / Q000534:rehabilitation / Q000601:surgery*; D005260:Female; D061826:Foot Orthoses; D058752:Free Tissue Flaps; D006333:Heart Failure / Q000401:mortality; D006801:Humans; D023821:Limb Salvage / Q000009:adverse effects / Q000379:methods* / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D016138:Walking
keywords: Diabetic foot; foot ulcer; free flap; limb salvage; peripheral artery disease