Abstract
The main etiologies of diabetic foot ulcer are divided into three categories; neuropathic (45%), neuroischemic (24%), and ischemic ulcer (16%). After selection of neuropathic DM ulcers that did not show significant arterial disease, free flap transfer was performed using flow-through arterial anastomosis to avoid amputation of the limb. Free flaps based on the subscapular artery system and the lateral femoral circumflex artery system were transplanted in 7 patients. The transplanted flaps were latissimus dorsi muscle flap in 2 cases, thoracodorsal artery perforator flap in 1 case, combined flap of latissimus dorsi muscle and serratus anterior muscle in 1 case, scapular flap in 1 case, serratus anterior fascia flap in 1 case and the anterolateral thigh flap in 1 case. Flow-through anastomosis to dorsalis pedis artery using circumflex scapular artery or thoracodorsal artery was performed. All flaps survived. Arterial flow on the distal side of the anastomosis was confirmed by Doppler flowmeter or angiography. Microsurgical flap transplantation is useful for minimum amputation of diabetic foot. Postoperative care has to be paid to neuropathy in these patients because the causes of their foot ulcers include sensory and motor disturbance.
