Intraoperative blood perfusion factors in free anterolateral thigh flap repair for diabetic foot ulcers: A retrospective analysis.

BACKGROUND

Diabetic foot ulcers (DFUs) in patients with type 2 diabetes (T2D) are associated with heightened risks of infection and amputation and thus require effective surgical interventions to enhance outcomes. Free anterolateral thigh (ALT) perforator flap is a promising reconstructive method; however, diabetic vasculopathy challenges optimal perfusion. This study analyzes factors influencing intraoperative blood perfusion in ALT flap repair for DFUs.

AIM

To identify key factors affecting intraoperative blood perfusion during free ALT perforator flap repair in patients with T2D and DFUs, thereby providing insights to improve surgical outcomes.

METHODS

This retrospective case-control study included 100 patients with T2D who underwent ALT flap repair at our institution between June 2016 and June 2024. Patients were categorized into normal ( = 50) and abnormal ( = 50) blood perfusion groups based on intraoperative perfusion assessments. Data on demographics, clinical characteristics, vascular status, metabolic control, and preoperative laboratory parameters were collected. Statistical analyses, including univariate and multivariate logistic regression, were conducted to identify significant predictive factors for perfusion outcomes.

RESULTS

Old age, high body mass index, long diabetes duration, and presence of diabetic peripheral neuropathy were associated with impaired perfusion. Abnormal perfusion was correlated with poor ankle-brachial index and elevated glycated hemoglobin (HbA1c), creatinine, triglycerides, and partial pressure of carbon dioxide. Conversely, high hemoglobin, albumin, and prealbumin levels and partial pressure of oxygen (PaO) were protective. Multivariate analysis identified diabetes duration, HbA1c, PaCO, PaO, and albumin as independent predictors of perfusion, underscoring the roles of metabolic control and vascular health.

CONCLUSION

Optimizing metabolic control, vascular health, and nutritional status was crucial to enhance intraoperative blood perfusion in diabetic patients undergoing ALT perforator flap repair for DFUs.