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Extracorporeal Pedicles for Free Flap Reconstruction in Diabetic Lower Extremity Wounds

  • Alejandro R. Gimenez (Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine) ;
  • Daniel Lazo (Hospital Especializado) ;
  • Salomao Chade (Hospital Especializado) ;
  • Alex Fioravanti (Hospital Especializado) ;
  • Olimpio Colicchio (Hospital Especializado) ;
  • Daniel Alvarez (Hospital Especializado) ;
  • Ernani Junior (Hospital Especializado) ;
  • Sarth Raj (Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine) ;
  • Amjed Abu-Ghname (Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine) ;
  • Marco Maricevich (Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine)
  • 투고 : 2022.01.17
  • 심사 : 2022.07.08
  • 발행 : 2022.11.15

초록

Diabetic foot ulcers are a severe complication of diabetes, and their management requires a multidisciplinary approach for optimal management. When treating these ulcers, limb salvage remains the ultimate goal. In this article, we present the "hanging" free flap for the reconstruction of chronic lower extremity diabetic ulcers. This two-staged approach involves standard free flap harvest and inset; however, following inset the "hanging" pedicle is covered within a skin graft instead of making extraneous incisions within the undisturbed soft tissues or tunnels that can compress the vessels. After incorporation, a second-stage surgery is performed in 4 to 6 weeks which entails pedicle division, flap inset revision, and end-to-end reconstruction of the recipient vessel. Besides decreasing the number of incisions on diabetic patients, our novel technique utilizing the "hanging" pedicle simplifies flap monitoring and inset and allows reconstruction of recipient vessels to reestablish distal blood flow.

키워드

참고문헌

  1. Kotha VS, Fan KL, Schwitzer JA, et al. Amputation versus free flap: long-term outcomes of microsurgical limb salvage and risk factors for amputation in the diabetic population. Plast Reconstr Surg 2021;147(03):742-750 https://doi.org/10.1097/PRS.0000000000007644
  2. Evans KK, Attinger CE, Al-Attar A, et al. The importance of limb preservation in the diabetic population. J Diabetes Complications 2011;25(04):227-231
  3. Oh TS, Lee HS, Hong JP. Diabetic foot reconstruction using free flaps increases 5-year-survival rate. J Plast Reconstr Aesthet Surg 2013;66(02):243-250 https://doi.org/10.1016/j.bjps.2012.09.024
  4. Suh HS, Oh TS, Hong JP. Innovations in diabetic foot reconstruction using supermicrosurgery. Diabetes Metab Res Rev 2016;32(Suppl 1):275-280 https://doi.org/10.1002/dmrr.2755
  5. Suh HP, Park CJ, Hong JP. Special considerations for diabetic foot reconstruction. J Reconstr Microsurg 2021;37(01):12-16 https://doi.org/10.1055/s-0040-1714431