Purpose : Diabetic patients often present with both peripheral arterial occlusive disease (PAD) and soft tissue defects. We report our approach for limb salvage with diabetic and ischemic foot ulcers by free muscle flap transfer and microsurgical revascularization.
Methods : In the past ten years, 72 patients (average 70 years; range 42 to 91) were treated for diabetic and ischemic foot ulcers. Among these patients, six selected patients underwent free LDmuscle flap transfer for soft tissue defects. Microsurgical revascularization was performed in 12 patients including distal bypass in 9, vein graft in 2, and venous arterialization in 1.
Results : All flaps were initially viable; however, one was lost on day 3 because of venous hypertension of the recipient vein and was treated with below-the-knee amputation. All microsurgical revascularizations were successful; however, both of the patients with a successful vein graft and with successful venous arterialization died 1 month postoperatively due to cardiac failure. Five of 6 patients with free LD- muscle flap transfer showed complete wound healing and are currently ambulatory at an average follow up of 20.3 months. Ten of 12 patients with microsurgical revascularization are ambulatory at an average follow up of 30.5 months, and primary patency rate was 100%.
Conclusions : Our microvascular approach was successful in preserving limb length and function in 83% of our patients. We believe that a microvascular surgical approach optimizes the treatment of diabetic and ischemic foot ulcers.