Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea.
Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea.
J Plast Reconstr Aesthet Surg. 2014 May;67(5):624-8. doi: 10.1016/j.bjps.2014.01.047. Epub 2014 Feb 7.
The limb-threatening large soft tissue defects that occur on the feet of type 2 diabetic patients have complex causes and are less likely to be corrected by free flap reconstruction compared to those in non-diabetic patients. We retrospectively analysed factors affecting the success of free flap transfer for necrotising soft tissue defects of the lower extremities in patients with type 2 diabetes.
This study included 33 diabetic patients whose feet were treated with free flap transfers. All patients had limb-threatening large soft tissue defects with tendon or bone exposure. The operative results were divided into three groups at 1 month post-operatively: the complete healing group, and the complication group, with either partial necrosis requiring additional simple procedures or flap failure with total necrosis. Nine preoperative factors were analysed: (1) ankle brachial index, (2) HbA1c, (3) BMI, (4) the smoking factor, (5) atherosclerotic calcifications (6) serum creatinine levels (>1.28 mg dL(-1) vs. <1.28 mg dL(-1)), (7) GFR, (8) wound infection and (9) wound defect size.
Of the 33 patients, 15 showed complete healing and 18 showed complications of the free flap (eight partial necrosis and 10 flap failure). No atherosclerotic calcifications were found in the patients in the complete healing group, although they were found in 12 patients in the complication group, and this difference was significant (p = 0.002). Patients with serum creatinine levels >1.28 mg dL(-1) had significantly higher free flap transfer complication rates than those with serum creatinine levels <1.28 mg dL(-1) (p = 0.038).
This study analysed the risk factors of free flap reconstruction for limb-threatening large soft tissue defects on the feet of type 2 diabetic patients. Serum creatinine levels >1.28 mg dL(-1) and atherosclerotic calcifications were confirmed as risk factors for flap survival.
2 型糖尿病患者足部发生的危及肢体的大型软组织缺损，其病因复杂，游离皮瓣重建的效果不如非糖尿病患者。我们回顾性分析了影响 2 型糖尿病患者下肢坏死性软组织缺损游离皮瓣移植成功的因素。
本研究纳入 33 例糖尿病患者，采用游离皮瓣转移治疗。所有患者均有肌腱或骨外露的肢体威胁性大型软组织缺损。术后 1 个月将手术结果分为三组：完全愈合组、并发症组，其中部分坏死需行附加简单手术，或皮瓣完全坏死。分析 9 项术前因素：（1）踝肱指数，（2）HbA1c，（3）BMI，（4）吸烟因素，（5）动脉粥样硬化钙化，（6）血清肌酐水平（>1.28mg/dL（-1）与<1.28mg/dL（-1）），（7）肾小球滤过率，（8）伤口感染，（9）伤口缺损大小。
33 例患者中，15 例完全愈合，18 例游离皮瓣出现并发症（8 例部分坏死，10 例皮瓣失败）。完全愈合组患者无动脉粥样硬化钙化，而并发症组患者中有 12 例存在动脉粥样硬化钙化，差异有统计学意义（p=0.002）。血清肌酐水平>1.28mg/dL（-1）的患者游离皮瓣转移并发症发生率明显高于血清肌酐水平<1.28mg/dL（-1）的患者（p=0.038）。
本研究分析了 2 型糖尿病患者足部危及肢体的大型软组织缺损游离皮瓣重建的危险因素。血清肌酐水平>1.28mg/dL（-1）和动脉粥样硬化钙化被证实为皮瓣存活的危险因素。
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