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J Reconstr Microsurg 2003; 19(8): 543-553
DOI: 10.1055/s-2004-815641
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Microsurgical Management of the Diabetic Foot

Christian Rainer1 , Anton H. Schwabegger1 , Romed Meirer1 , Reinhold Perkmann2 , Marina Ninkovic3 , Milomir Ninkovic1
  • 1Department of Plastic and Reconstructive Surgery and the Ludwig Boltzmann Institute for Quality Control in Plastic and Reconstructive Surgery, Leopold-Franzens University, Innsbruck, Austria
  • 2Department of Vascular Surgery, Leopold-Franzens University, Innsbruck, Austria
  • 3Department of Surgery, Unit for Physical Medicine, Leopold-Franzens University, Innsbruck, Austria
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Publication History

Publication Date:
14 January 2004 (online)

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ABSTRACT

Allthough there has been dramatic progress in limb salvage in recent decades, management of nonhealing wounds in diabetic patients continues to present a dilemma for the reconstructive surgeon. However, the acceptance of free-flap resurfacing of diabetic foot ulcers has increased in recent years. This study reviews 10 microvascular free muscle flaps in nine patients over a mean follow-up period of 44 months. Five patients had evidence of peripheral vascular disease. There was one flap loss, and nine flaps were transferred successfully. No perioperative mortality was encountered. The operations required a long, costly hospitalization (average hospital stay was 40 days). Seven of eight patients whose flaps survived had complications related to the free-flap recipient site. These seven patients underwent 20 secondary surgical procedures due to arterial and venous thrombosis, partial necrosis of the skin grafts, minor local infections, and gangrene or necrosis of the remaining toes. In three patients, progressive ischemic necrosis of the remaining toes, with total survival of the flap, was attributed to a microvascular steal phenomenon. However, all eight patients whose flaps survived subsequently ambulated on their flaps. The study demonstrates that microvascular surgery may result in functional lower-extremity salvage in diabetic patients with foot wounds that are not treatable by local flaps or skin grafts, and are destined for amputation.

KEYWORDS

Diabetic foot - microsurgery - steal phenomenon

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