Clinical outcome of treatment of diabetic foot ulcers using supermicrosurgery technique

LI Jun; WEI Yong; SHU Zhenghua; TONG Zhe; CHEN Bo; WANG Xixun; PAN Yue; and DING Chaoqi.

PDF(2707 KB)

Medical Journal of the Chinese People Armed Police Forces ›› 2018, Vol. 29 ›› Issue (9) : 853-856.

ORIGINAL ARTICLES

Clinical outcome of treatment of diabetic foot ulcers using supermicrosurgery technique

LI Jun, WEI Yong, SHU Zhenghua, TONG Zhe, CHEN Bo, WANG Xixun, PAN Yue, and DING Chaoqi.

Author information +

History +

Abstract

Objective To evaluate the clinical outcome of diabetic foot reconstruction with supermicrosurgery techniques.Methods Thirty-five cases of diabetic foot reconstruction using supermicrosurgery techniques between January 2015 and December 2016 were reviewed. The average age of patients was 52.4 years and average follow-up was 18.1 months. Preoperative Doppler examination and visual inspection during the debridement were conducted to choose the adequate recipient artery. Reconstruction was performed with perforator flaps using the supermicrosurgery approach. The clinical outcome was evaluated with the flap survival rate and limb salvage rate.Results Among the 35 cases, there were five cases of flap loss, so the flap survival rate was 85.7 percent. Among the five cases of flap loss, two patients achieved secondary healing after debridement and skin grafting, and the rest were eventually amputated and the overall limb salvage rate was 91.4 percent. The SAS score and SDS score of all the patients decreased significantly after operation, while the BI index increased significantly (P<0.05).Conclusions Compared with classic skin flap surgery, the supermicrosurgery approach to diabetic foot wound repair is effective. The area damage is smaller and the recovery is faster. The key to this technique is to select appropriate receptor vessels

Key words

diabetic foot / supermicrosurgery / perforator artery

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

LI Jun, WEI Yong, SHU Zhenghua, TONG Zhe, CHEN Bo, WANG Xixun, PAN Yue, and DING Chaoqi.. Clinical outcome of treatment of diabetic foot ulcers using supermicrosurgery technique[J]. Medical Journal of the Chinese People Armed Police Forces. 2018, 29(9): 853-856

References

[1] Margolis D J, Hoffstad O, Nafash J, et al. Location, location, location: geographic clustering of lower-extremity amputation among medicare beneficiaries with diabetes[J]. Diabetes Care, 2011, 34(11): 2363-2367.
[2] Bragg F, Holmes M V, Iona A, et al. Association between diabetes and cause-specific mortality in rural and urban areas of China [J]. JAMA, 2017, 317(3): 280-289.
[3] Colen L B. Limb salvage in the patient with severe peripheral vascular disease: the role of microsurgical free-tissue transfer [J]. Plast Reconstr Surg, 1987, 79(3): 389-395.
[4] Fitzgerald O’Connor E J, Vesely M, Holt P J, et al. A systematic review of free tissue transfer in the management of non-traumatic lower extremity wounds in patients with diabetes [J]. Eur J Vasc Endovasc Surg, 2011, 41(3): 391-399.
[5] 何晓清, 徐永清. 超级显微外科介绍 [J]. 创伤外科杂志, 2017, 19(1): 1-4.
[6] Koshima I, Yamamoto T, Narushima M, et al. Perforator flaps and supermicrosurgery [J]. Clin Plast Surg, 2010, 37(4): 683-689.
[7] Masia J, Olivares L, Koshima I, et al. Barcelona consensus on supermicrosurgery [J]. J Reconstr Microsurg, 2014, 30(1): 53-58.
[8] Yamamoto T, Narushima M, Yoshimatsu H, et al. Minimally invasive lymphatic supermicrosurgery (MILS): indocyanine green lymphography-guided simultaneous multisite lymphaticovenular anastomoses via millimeter skin incisions [J]. Ann Plast Surg, 2014, 72(1): 67-70.
[9] Hong J P, Koshima I. Using perforators as recipient vessels (supermicrosurgery) for free flap reconstruction of the knee region [J]. Ann Plast Surg, 2010, 64(3): 291-293.[10] Mills J L Sr, Armstrong D G, Andros G. Rescuing sisyphus: the team approach to amputation prevention [J]. J Am Podiatr Med Assoc, 2010, 100(5): 315-316.
[11] Rudrappa S, Game F, Jeffcoate W. Recurrence of the acute Charcot foot in diabetes [J]. Diabet Med, 2012, 29(6): 819-821.
[12] Oh T S, Lee H S, Hong J P. Diabetic foot reconstruction using free flaps increases 5-year-survival rate [J]. J Plast Reconstr Aesthet Surg, 2013, 66(2): 243-250.
[13] Clemens M W, Attinger C E. Angiosomes and wound care in the diabetic foot [J]. Foot Ankle Clin, 2010, 15(3): 439-464.
[14] Attinger C, Cooper P, Blume P, et al. The safest surgical incisions and amputations applying the angiosome principles and using the Doppler to assess the arterial-arterial connections of the foot and ankle [J]. Foot Ankle Clin, 2001, 6(4): 745-799.
[15] 傅尚俊, 杨晓东, 杨锦, 等. 游离股前外皮瓣移植术后静脉危象的病因探讨 [J]. 中华手外科杂志, 2015, 31(4): 313-314.
[16] 郝丽文. 带蒂转移穿支皮瓣远端坏死原因的实验研究[D]. 济南:山东大学, 2007.