Vastus lateralis free flap for soft tissue coverage of a lower extremity diabetic ulcer

The use of propeller perforator flaps for diabetic limb salvage: a retrospective review of 25 cases

Background

Peripheral vascular disease and/or diabetic neuropathy represent one of the main etiologies for the development of lower leg and/or diabetic foot ulcerations, and especially after acute trauma or chronic mechanical stress. The reconstruction of such wounds is challenging due to the paucity of soft tissue resources in this region. Various procedures including orthobiologics, skin grafting (SG) with or without negative pressure wound therapy and local random flaps have been used with varying degrees of success to cover diabetic lower leg or foot ulcerations. Other methods include: local or regional muscle and fasciocutaneous flaps, free muscle and fasciocutaneous, or perforator flaps, which also have varying degrees of success.

Patients and methods

This article reviews 25 propeller perforator flaps (PPF) which were performed in 24 diabetic patients with acute and chronic wounds involving the foot and/or lower leg. These patients were admitted beween 2008 and 2011. Fifteen PPF were based on perforators from the peroneal artery, nine from the posterior tibial artery, and one from the anterior tibial artery.

Results

A primary healing rate (96%) was obtained in 18 (72%) cases. Revisional surgery and SG for skin necrosis was performed in six (24%) cases with one complete loss of the flap (4%) which led to a lower extremity amputation.

Conclusions

The purpose of this article is to review the use of PPF as an effective method for soft tissue coverage of the diabetic lower extremity and/or foot. In well-controlled diabetic patients that present with at least one permeable artery in the affected lower leg, the use of PPF may provide an alternative option for soft tissue reconstruction of acute and chronic diabetic wounds.

Flap reconstruction of distal lower extremity wounds in diabetic patients

Lower extremity diabetic wounds have been a challenge to clinical surgeons because of the higher risk of limb ischemia, soft-tissue infection, and soft-tissue loss caused by the pathology of the disease. In the published data, the most commonly used reconstruction techniques include pedicled flaps, microsurgical muscle or musculocutaneous flaps, and microsurgical fasciocutaneous or perforator flaps. However, there is still no consensus about which type of flap should be preferred among various reconstructive options. It is therefore the aim of this study to review current articles describing distal lower extremity flap reconstruction in patients with diabetes to survey reported results from the literature.