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DOI: 10.1055/s-0042-1758635
Extracorporeal Pedicles for Free Flap Reconstruction in Diabetic Lower Extremity Wounds
Sources of Support None.
Abstract
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.
Keywords
diabetic foot ulcers - hanging pedicle - microvascular reconstruction - free tissue transferFinancial Disclosures/Commercial Associations
None.
Author Contribution
Conceptualization: M Maricevich. Data curation: AR Gimenez, S Raj, A Abu-Ghname. Methodology: M Maricevich. Project administration: M Maricevich, D Lazo, A Fioravanti, O Colicchio, D Alvarez, E Junior. Visualization: M Maricevich. Writing - original draft: AR Gimenez, S Raj, A Abu-Ghname. Writing – review & editing: AR Gimenez, A Abu-Ghname, M Maricevich, D Lazo, A Fioravanti, O Colicchio, D Alvarez, E Junior.
Products/Devices/Drugs
None.
Patient Consent
The patients provided written informed consent for the publication and the use of their images.
Publication History
Received: 17 January 2022
Accepted: 08 July 2022
Article published online:
13 December 2022
© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
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- 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
- 4 Suh HS, Oh TS, Hong JP. Innovations in diabetic foot reconstruction using supermicrosurgery. Diabetes Metab Res Rev 2016; 32 (Suppl 1): 275-280
- 5 Suh HP, Park CJ, Hong JP. Special considerations for diabetic foot reconstruction. J Reconstr Microsurg 2021; 37 (01) 12-16