From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital.
Plast Reconstr Surg. 2021 Mar 1;147(3):742-750. doi: 10.1097/PRS.0000000000007644.
Reconstructive microsurgery is an effective limb-saving option for nonhealing lower extremity wounds in diabetic patients. However, the ability to predict the future need for amputation is unclear. This article seeks to identify risk factors for amputation following microsurgical free tissue transfer in the diabetic lower extremity.
Diabetic patients undergoing lower extremity free flap surgery between August of 2011 and January of 2018 performed by a single surgeon were identified retrospectively. Patient comorbidities, reconstructive conditions and flap traits, microsurgical outcomes, and long-term outcomes were examined. Variables conferring risk for future amputation were examined by means of regression analysis.
Sixty-four patients met the criteria. The overall immediate flap success rate was 94 percent (60 of 64). Long term, 50 patients (78.1 percent) underwent successful salvage, and 14 patients (21.9 percent) required major amputation. Acute flap loss resulted in four amputations, and delayed complications (hematoma, infection, recurrent nonhealing) resulted in 10 amputations. The average time to amputation was 5.6 months. Risk factors for amputation were end-stage renal disease (OR, 30.7; p = 0.0087), hindfoot wounds (OR, 4.6; p = 0.020), elevated hemoglobin A1C level greater than 8.4 percent (OR, 1.4; p = 0.05), and positive wound cultures (OR, 6.1; p = 0.003).
Multiple comorbidities and poor glucose control were identified as risk factors for amputation after free flap limb salvage. However, successful limb preservation is possible.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
对于糖尿病患者非愈合性下肢创面，重建显微外科是一种有效的保肢选择。然而，对于预测未来截肢的能力尚不清楚。本文旨在确定糖尿病下肢显微外科游离组织移植后截肢的危险因素。
回顾性分析 2011 年 8 月至 2018 年 1 月由同一位外科医生进行的下肢游离皮瓣手术的糖尿病患者。检查患者的合并症、重建情况和皮瓣特征、显微外科结果和长期结果。通过回归分析检查未来截肢的风险因素。
符合标准的患者共 64 例。总的即刻皮瓣成功率为 94%（60/64）。长期随访中，50 例（78.1%）患者成功挽救，14 例（21.9%）患者需要进行主要截肢。急性皮瓣失活导致 4 例截肢，延迟并发症（血肿、感染、复发性不愈合）导致 10 例截肢。截肢的平均时间为 5.6 个月。截肢的危险因素包括终末期肾病（OR，30.7；p = 0.0087）、后足创面（OR，4.6；p = 0.020）、糖化血红蛋白水平大于 8.4%（OR，1.4；p = 0.05）和阳性创面培养（OR，6.1；p = 0.003）。
多种合并症和血糖控制不佳被确定为游离皮瓣肢体挽救后截肢的危险因素。然而，成功的肢体保存是可能的。
临床问题/证据水平：风险，III 级。
