St George's Vascular Institute, St Georges Healthcare NHS Trust, London, UK.
Eur J Vasc Endovasc Surg. 2011 Mar;41(3):391-9. doi: 10.1016/j.ejvs.2010.11.013. Epub 2010 Dec 16.
Wounds of the lower limb in patients with diabetes are frequently difficult to heal. Some wounds fail to heal despite optimal medical and surgical care. This review examines the evidence for whether free tissue transfer techniques may reduce the requirement of amputation in these patients.
A systematic review.
MATERIALS & METHODS: Pubmed, Embase, AMED, SCOPUS and CINAHL and Cochrane Library were searched for all articles on free tissue transfer in lower limb wounds in patients with diabetes (September 2010). Current experience, indications and outcomes were analysed.
528 patients from 18 studies were included in the systematic review. 66% of patients had concomitant revascularisation with bypass surgery. 63% of flaps were muscle based, 35% fasciocutaneous and 1.7% omental. Pooled in-hospital mortality rate was 4.4%, flap survival was 92% and limb salvage rate of 83.4% over a 28 months average follow-up time.
In conclusion free tissue transfer achieves successful wound healing in selected patients with diabetes and difficult to heal wounds that would have required amputation. Pre-operative optimisation of vascular supply and eradication of infection is key to success. Objective wound assessment scores and a clear multidisciplinary team (MDT) approach would improve patient care.
糖尿病患者下肢的创伤通常难以愈合。一些伤口尽管经过了最佳的医疗和手术护理，但仍无法愈合。本综述旨在探讨游离组织转移技术是否可能降低这些患者截肢的必要性。
系统评价。
通过 Pubmed、Embase、AMED、SCOPUS 和 CINAHL 以及 Cochrane Library，检索了 2010 年 9 月所有关于糖尿病患者下肢创伤游离组织转移的文章。分析了当前的经验、适应证和结果。
系统综述纳入了来自 18 项研究的 528 名患者。66%的患者同时进行了旁路手术的血管再通。63%的皮瓣为肌肉皮瓣，35%为筋膜皮瓣，1.7%为网膜皮瓣。住院期间死亡率为 4.4%，皮瓣存活率为 92%，28 个月平均随访时的肢体存活率为 83.4%。
总之，游离组织转移术可成功治愈糖尿病患者和那些需要截肢的难治性创伤。术前优化血管供应和消除感染是成功的关键。客观的伤口评估评分和明确的多学科团队（MDT）方法将改善患者的治疗效果。
