Ou Chia-Yu, Wu Meng-Si, Lin Mei-Chen, Chang Chun-Ming
Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan, Taiwan.
Division of Plastic surgery, Department of surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; College of Medicine, Tzu Chi University, Hualien, Taiwan.
J Plast Reconstr Aesthet Surg. 2022 Aug;75(8):2511-2519. doi: 10.1016/j.bjps.2022.04.024. Epub 2022 Apr 25.
In Taiwan, the prevalence of diabetes mellitus complicated by end-stage renal disease (ESRD) has been increasing and diabetes-related foot amputation is commonplace. In recent years, limb salvage has become top priority. The long-term outcomes of patients on hemodialysis undergoing diabetic foot reconstruction using free flaps remain unknown.
Data from the National Health Insurance Research Database on hemodialysis patients with type 2 diabetes who received amputation or free flap reconstruction surgery for diabetic foot ulcer were analyzed from 2000 to 2013 using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. After 1:4 propensity score matching, 86 and 344 patients were assigned to the free flap reconstruction and amputation groups, respectively.
The 5-year survival rate was significantly higher in patients who received free flap compared to the amputated group (1-year survival rate = 80.0% vs. 67.6%, p = 0.030; 3-year survival rate = 49.7% vs. 35.5%, p = 0.024; 5-year rate=30.1% vs. 19.9%, p = 0.018; however, after 5 years, the overall long-term survival rate was similar in both groups (p = 0.064). Patients who had lower limb amputation after flap reconstruction were susceptible to mortality (adjusted HR = 1.39; p = 0.069). Peripheral arterial disease was a dependent risk factor (HR = 1.45; p = 0.037) for long-term survival, whereas old age (> 75 years; HR = 1.65; p = 0.004), cerebrovascular disease (adjusted HR = 1.36; p = 0.011), and sepsis (adjusted HR = 1.85; p = 0.035) served as independent risk factors. Hemodialysis patients with diabetic foot ulcer who had limb salvaged showed a higher 5-year survival rate as compared to the amputated group.
在台湾，糖尿病合并终末期肾病（ESRD）的患病率一直在上升，糖尿病相关的足部截肢很常见。近年来，保肢已成为首要任务。接受游离皮瓣进行糖尿病足重建的血液透析患者的长期预后仍然未知。
使用国际疾病分类第九版临床修订本（ICD-9-CM）编码，分析了2000年至2013年国家健康保险研究数据库中因糖尿病足溃疡接受截肢或游离皮瓣重建手术的2型糖尿病血液透析患者的数据。经过1:4倾向评分匹配后，分别有86例和344例患者被分配到游离皮瓣重建组和截肢组。
接受游离皮瓣的患者5年生存率显著高于截肢组（1年生存率=80.0%对67.6%，p=0.030；3年生存率=49.7%对35.5%，p=0.024；5年生存率=30.1%对19.9%，p=0.018）；然而，5年后，两组的总体长期生存率相似（p=0.064）。皮瓣重建后进行下肢截肢的患者易死亡（调整后HR=1.39；p=0.069）。外周动脉疾病是长期生存的依赖危险因素（HR=1.45；p=0.037），而老年（>75岁；HR=1.65；p=0.004）、脑血管疾病（调整后HR=1.36；p=0.011）和败血症（调整后HR=1.85；p=0.035）是独立危险因素。与截肢组相比，接受保肢治疗的糖尿病足溃疡血液透析患者5年生存率更高。
