Suh Hyunsuk P, Kedar Daniel J, Lee Yeon Hoon, Lee Pil Hyung, Lee Seung-Whan, Hong Joon Pio
From the Departments of Plastic Surgery.
Diabetic Center, Asan Medical Centerand.
Plast Reconstr Surg. 2023 Mar 1;151(3):485e-494e. doi: 10.1097/PRS.0000000000009935. Epub 2022 Nov 29.
Free flap after lower extremity revascularization may enable limb salvage in defects after critical limb ischemia. This study examined the outcomes of reconstruction of ischemic diabetic foot according to the severity of the vessel occlusion and assessed whether recanalized vessels may serve as a reliable recipient vessel.
A total of 62 patients who underwent diabetic foot reconstruction with free flaps after successful percutaneous transluminal angioplasty (PTA) from February of 2010 to February of 2016 were identified and divided into three groups: group 1, nonoccluded vessels as recipient ( n = 11); group 2, recanalized artery after PTA for partially occluded artery ( n = 30); and group 3, recanalized artery after PTA for completely occluded artery ( n = 21).
Flap survival was statistically higher in group 2 (90%) compared with group 3 (67%) ( P < 0.05). Subsequent major amputation was significantly lower in groups 1 and 2 [0/7 and 1/30 (3.3%)] compared with group 3 [5/21 (23.8%)] ( P < 0.05). The patient survival and limb salvage rate was 90.9% at 1 and 3 years in group 1, 89.8% at 1 year and 86.3% at 3 and 5 years in group 2, and 76.2% at 1, 3, and 5 years in group 3. This difference was not statistically significant ( P = 0.485).
The use of recanalized vessels after PTA can be safe for partially occluded arteries but requires caution for completely occluded arteries. Using completely occluded vessels after PTA can be attempted when other options are not available and achieves a 76% chance of limb salvage.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
下肢血运重建术后的游离皮瓣可使严重肢体缺血后的肢体得以挽救。本研究根据血管闭塞的严重程度检查了缺血性糖尿病足重建的结果，并评估了再通血管是否可作为可靠的受区血管。
确定了2010年2月至2016年2月期间在成功进行经皮腔内血管成形术（PTA）后接受游离皮瓣糖尿病足重建的62例患者，并将其分为三组：第1组，以未闭塞血管作为受区（n = 11）；第2组，部分闭塞动脉经PTA后再通的动脉（n = 30）；第3组，完全闭塞动脉经PTA后再通的动脉（n = 21）。
第2组皮瓣存活率（90%）在统计学上高于第3组（67%）（P < 0.05）。第1组和第2组随后的大截肢率显著低于第3组[0/7和1/30（3.3%）对比5/21（23.8%）]（P < 0.05）。第1组1年和3年时患者生存率和肢体挽救率为90.9%，第2组1年时为89.8%，3年和5年时为86.3%，第3组1年、3年和5年时为76.2%。这种差异无统计学意义（P = 0.485）。
PTA后使用再通血管对部分闭塞动脉可能是安全的，但对完全闭塞动脉则需谨慎。当没有其他选择时，可尝试使用PTA后完全闭塞的血管，肢体挽救几率可达76%。
临床问题/证据水平：治疗性，III级
