What is the impact of infrapopliteal endovascular intervention on free flap survival in diabetic foot reconstruction?
Abstract Background The combination of endovascular intervention and microvascular free flap transfer has been effectively used for chronic ischemic wounds of lower limb. The aim of this study was to determine the influence of angioplasty on free flap survival in diabetic foot ulcer reconstruction....
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-01-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13018-020-02173-9 |
| _version_ | 1817997528346394624 |
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| author | Duy Quang Thai Dong Hwan Lee Woo Beom Lee Hyung Min Hahn Il Jae Lee |
| author_facet | Duy Quang Thai Dong Hwan Lee Woo Beom Lee Hyung Min Hahn Il Jae Lee |
| author_sort | Duy Quang Thai |
| collection | DOAJ |
| description | Abstract Background The combination of endovascular intervention and microvascular free flap transfer has been effectively used for chronic ischemic wounds of lower limb. The aim of this study was to determine the influence of angioplasty on free flap survival in diabetic foot ulcer reconstruction. Methods A retrospective research was conducted for 46 diabetic patients with chronic ulcer of the foot. All patients underwent free flap reconstruction because of their non-healing wound with tendon or bone exposure. Patient’s demography, clinical data related to vascular status, vascular intervention, and free flap transfer procedure were collected. Flap survival rate was compared between the group with severe arterial stenosis group and non-severe stenosis group. It was also compared among groups with different revascularization results. Results The average age of patients was 56.2 ± 10.8 years. There were 14 (30.4%) men and 32 (69.6%) women. Of 46 patients, 23 (50%) had severe infrapopliteal arterial stenosis. All 23 patients underwent endovascular intervention. Their final results of the pedal arch were type 1 in 13 patients, type 2A in 7 patients, type 2B in 2 patients, and type 3 in 1 patient. Total flap necrosis was found in 5 (10.9%) cases, marginal necrosis in 4 (8.7%) cases, and wound dehiscence in 4 (8.7%) cases. There was no significant difference in flap loss between severe arterial stenosis patients and non-severe arterial stenosis patients. In the severe arterial stenosis group, after endovascular intervention, patients with type 1 of pedal arch had a significantly lower rate of total flap necrosis than others. There was no association between the use of revascularized recipient artery and flap survival. Conclusions Our study revealed that the quality of pedal arch was crucial for free flap survival. Thus, PTA should aim to re-establish a complete pedal arch to increase wound healing rate and flap success. |
| first_indexed | 2024-04-14T02:39:35Z |
| format | Article |
| id | doaj.art-ea334940f97448308ab39bd04e775276 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-14T02:39:35Z |
| publishDate | 2021-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-ea334940f97448308ab39bd04e7752762022-12-22T02:17:15ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2021-01-011611710.1186/s13018-020-02173-9What is the impact of infrapopliteal endovascular intervention on free flap survival in diabetic foot reconstruction?Duy Quang Thai0Dong Hwan Lee1Woo Beom Lee2Hyung Min Hahn3Il Jae Lee4Department of Plastic and Reconstructive Surgery, Ajou University School of MedicineDepartment of Plastic and Reconstructive Surgery, Ajou University School of MedicineDepartment of Plastic and Reconstructive Surgery, Ajou University School of MedicineDepartment of Plastic and Reconstructive Surgery, Ajou University School of MedicineDepartment of Plastic and Reconstructive Surgery, Ajou University School of MedicineAbstract Background The combination of endovascular intervention and microvascular free flap transfer has been effectively used for chronic ischemic wounds of lower limb. The aim of this study was to determine the influence of angioplasty on free flap survival in diabetic foot ulcer reconstruction. Methods A retrospective research was conducted for 46 diabetic patients with chronic ulcer of the foot. All patients underwent free flap reconstruction because of their non-healing wound with tendon or bone exposure. Patient’s demography, clinical data related to vascular status, vascular intervention, and free flap transfer procedure were collected. Flap survival rate was compared between the group with severe arterial stenosis group and non-severe stenosis group. It was also compared among groups with different revascularization results. Results The average age of patients was 56.2 ± 10.8 years. There were 14 (30.4%) men and 32 (69.6%) women. Of 46 patients, 23 (50%) had severe infrapopliteal arterial stenosis. All 23 patients underwent endovascular intervention. Their final results of the pedal arch were type 1 in 13 patients, type 2A in 7 patients, type 2B in 2 patients, and type 3 in 1 patient. Total flap necrosis was found in 5 (10.9%) cases, marginal necrosis in 4 (8.7%) cases, and wound dehiscence in 4 (8.7%) cases. There was no significant difference in flap loss between severe arterial stenosis patients and non-severe arterial stenosis patients. In the severe arterial stenosis group, after endovascular intervention, patients with type 1 of pedal arch had a significantly lower rate of total flap necrosis than others. There was no association between the use of revascularized recipient artery and flap survival. Conclusions Our study revealed that the quality of pedal arch was crucial for free flap survival. Thus, PTA should aim to re-establish a complete pedal arch to increase wound healing rate and flap success.https://doi.org/10.1186/s13018-020-02173-9Diabetic footPeripheral arterial diseaseEndovascular interventionPercutaneous transluminal AngioplastyFree flap |
| spellingShingle | Duy Quang Thai Dong Hwan Lee Woo Beom Lee Hyung Min Hahn Il Jae Lee What is the impact of infrapopliteal endovascular intervention on free flap survival in diabetic foot reconstruction? Journal of Orthopaedic Surgery and Research Diabetic foot Peripheral arterial disease Endovascular intervention Percutaneous transluminal Angioplasty Free flap |
| title | What is the impact of infrapopliteal endovascular intervention on free flap survival in diabetic foot reconstruction? |
| title_full | What is the impact of infrapopliteal endovascular intervention on free flap survival in diabetic foot reconstruction? |
| title_fullStr | What is the impact of infrapopliteal endovascular intervention on free flap survival in diabetic foot reconstruction? |
| title_full_unstemmed | What is the impact of infrapopliteal endovascular intervention on free flap survival in diabetic foot reconstruction? |
| title_short | What is the impact of infrapopliteal endovascular intervention on free flap survival in diabetic foot reconstruction? |
| title_sort | what is the impact of infrapopliteal endovascular intervention on free flap survival in diabetic foot reconstruction |
| topic | Diabetic foot Peripheral arterial disease Endovascular intervention Percutaneous transluminal Angioplasty Free flap |
| url | https://doi.org/10.1186/s13018-020-02173-9 |
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