Ozkan Omer, Coşkunfirat O Koray, Ozgentaş H Ege
Department of Plastic and Reconstructive Surgery, Akdeniz University School of Medicine, Antalya 07059, Turkey.
Microsurgery. 2005;25(2):107-12. doi: 10.1002/micr.20094.
As microsurgery advances, microsurgical free-tissue transfers have become the reconstructive method of choice over staged or primary amputation, and enabling independent ambulation in difficult lower-extremity wounds. In this report, we present our experiences with free-tissue transfer for the reconstruction of soft-tissue defects in 13 diabetic foot ulcers. Following radical debridement, soft-tissue reconstruction was achieved in the following ways: anterolateral thigh fasciocutaneous flap in 5 patients, radial forearm fasciocutaneous flap in 3 patients, lateral arm fasciocutaneous flap in 1 patient, gracilis musculocutaneous flap in 1 patient, tensor fascia latae flap in 1 patient, deep inferior epigastric perforator flap in 1 patient, and a parascapular flap in the remaining patient. In 8 cases, diabetic wounds were in the foot, while wounds were at the level of the lower leg in the remaining patients. In all patients, vascular patency was confirmed by the Doppler technique. In suspicious cases, arteriography was then performed. While all flaps survived well in the postoperative period, one patient died from cardiopulmonary problems on postoperative day 16 in an intensive care unit. Amputation was necessary in the early postoperative period because of healing problems. In the remaining 10 cases, all flaps survived intact. In one case, arterial revision was performed successfully. The ultimate limb salvage rate was 83% for the 12 patients. Independent ambulation was achieved in these cases. During the follow-up period of 8 months to 2 years, no ulcer recurrence was noted, and no revascularization or vascular bypass surgery was needed before or after the free-tissue transfers. The authors conclude that free-tissue transfer for diabetic foot ulcers is a reliable procedure, despite pessimistic opinions regarding the flap survival and low limb salvage rates. It should be considered a useful reconstructive option for serious defects in well-selected cases.
随着显微外科技术的进步，显微外科游离组织移植已成为优于分期或一期截肢的重建方法，能够使下肢复杂伤口实现独立行走。在本报告中，我们介绍了13例糖尿病足溃疡软组织缺损游离组织移植重建的经验。在彻底清创后，通过以下方式实现软组织重建：5例采用股前外侧筋膜皮瓣，3例采用桡动脉前臂筋膜皮瓣，1例采用上臂外侧筋膜皮瓣，1例采用股薄肌肌皮瓣，1例采用阔筋膜张肌皮瓣，1例采用腹壁下深动脉穿支皮瓣，其余1例采用肩胛旁皮瓣。8例糖尿病伤口位于足部，其余患者伤口位于小腿水平。所有患者均通过多普勒技术确认血管通畅。可疑病例则进行动脉造影。术后所有皮瓣均存活良好，但1例患者在术后第16天于重症监护病房因心肺问题死亡。由于愈合问题，术后早期有必要进行截肢。其余10例中，所有皮瓣均完整存活。1例成功进行了动脉修复。12例患者的最终肢体挽救率为83%。这些病例均实现了独立行走。在8个月至2年的随访期内，未发现溃疡复发，游离组织移植前后均无需进行血管再通或血管搭桥手术。作者得出结论，尽管对于皮瓣存活和低肢体挽救率存在悲观观点，但糖尿病足溃疡的游离组织移植是一种可靠的手术方法。对于精心挑选的严重缺损病例，应将其视为一种有用的重建选择。
