ewma 2013 - ep462 - how about the free flap as the first choice of treatment for diabetic foot?:...
TRANSCRIPT
How about the Free Flap as the
First Choice of Treatment for
Diabetic foot?: Tips for Success.
Donghyeok Shin, M.D., Ph.D.
Department of Plastic and Reconstructive Surgery
Konkuk University Medical Center
What Should Reconstruction Provide?
• Well-vascularized tissue
• Protection
– Proper padding
– Durable skin
– Enduring shearing force
• Good contour
Conflict of Local and Distant Flap
• When
–Significant occlusion of vasculature
–Distal circulation depending on few
collaterals
Patients and Methods
• From September 2010 to May 2012, 45 patients underwent free flap for their diabetic foot reconstruction. Preoperatively, diabetic period, HbA1c, nephropathy, cardiac dysfunction, and angiogram were investigated. Selection of recipient vessel was made by preoperative angiography and Doppler tracing. If indicated, dobutamine was used to increase cardiac output and blood pressure.
Results
• Overall, there were 7 total and 9 partial losses. 39 patients had preoperative interventional angioplasty and 7 total losses occurred in this group. In six patients, major vessels were used as recipient. Among six cases, 3 flaps were totally failed, and one showed partial loss. In case of 4 end-stage renal disease(ESRD), every flap survived completely. In five cases that had dobutamine infusion, there were one total and one partial loss.