游离皮瓣在糖尿病足溃疡修复中的应用研究进展

简扬; 魏在荣; 陈伟; 张演基; 唐铭远; 钟云雪; 刘陈肖笑

doi:10.3760/cma.j.cn501225-20221216-00539

游离皮瓣在糖尿病足溃疡修复中的应用研究进展

doi: 10.3760/cma.j.cn501225-20221216-00539

遵义医科大学附属医院烧伤整形外科，遵义　　563003

基金项目:

省部共建协同创新中心项目 2020-39

贵州省科技计划项目 2020-5012

遵义市科技计划项目 2021-3

详细信息

通讯作者:
魏在荣，Email：zairongwei@163.com

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- 被引次数: 0
出版历程
- 收稿日期: 2022-12-16

Research advances on the application of free flaps in repairing diabetic foot ulcers

Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China

Funds:

Collaborative Innovation Center of Chinese Ministry of Education 2020-39

Science and Technology Plan Project of Guizhou Province of China 2020-5012

Science and Technology Plan Project of Zunyi City 2021-3

More Information

Corresponding author: Wei Zairong, Email: zairongwei@163.com

摘要

摘要: 游离皮瓣已被成功用于糖尿病足溃疡（DFU）的修复，可降低截肢率，维持患者正常步态，提高患者生活质量。然而，采用游离皮瓣修复DFU仍面临许多挑战，有很多亟待解决的问题。该文总结了游离皮瓣修复DFU的患者选择、术前注意事项、皮瓣类型、血管吻合方式、临床效果及存在的问题。
- 糖尿病足 /
- 溃疡 /
- 截肢术 /
- 游离皮瓣 /
- 血糖控制
Abstract: Free flaps have been successfully used in the repair of diabetic foot ulcers (DFUs), which can reduce amputation rate, maintain normal gait of patients, and improve life quality of patients. However, there are still many challenges in the repair of DFUs with free flaps, and many problems need to be solved. This paper summarizes the selection of patients, preoperative cautions, types of flaps, methods of vascular anastomosis, clinical effects, and existing problems in using free skin flaps for repairing DFUs.
- Diabetic foot /
- Ulcer /
- Amputation /
- Free flaps /
- Glycemic control
所有作者均声明不存在利益冲突

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参考文献(38)

[1]	WangA,LvG,ChengX,et al.Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease (2020 edition)[J/OL].Burns Trauma,2020,8:tkaa017[2022-12-16].https://pubmed.ncbi.nlm.nih.gov/32685563/.DOI: 10.1093/burnst/tkaa017.
[2]	ZhangP,LuJ,JingY,et al.Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis †[J].Ann Med,2017,49(2):106-116.DOI: 10.1080/07853890.2016.1231932.
[3]	SuhHS,OhTS,LeeHS,et al.A new approach for reconstruction of diabetic foot wounds using the angiosome and supermicrosurgery concept[J].Plast Reconstr Surg,2016,138(4):702e-709e.DOI: 10.1097/PRS.0000000000002401.
[4]	Fitzgerald O'ConnorEJ,VeselyM,HoltPJ,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.DOI: 10.1016/j.ejvs.2010.11.013.
[5]	LeeZH,DaarDA,StranixJT,et al.Free-flap reconstruction for diabetic lower extremity limb salvage[J].J Surg Res,2020,248:165-170.DOI: 10.1016/j.jss.2019.12.008.
[6]	OhTS,LeeHS,HongJP.Diabetic foot reconstruction using free flaps increases 5-year-survival rate[J].J Plast Reconstr Aesthet Surg,2013,66(2):243-250.DOI: 10.1016/j.bjps.2012.09.024.
[7]	KothaVS,FanKL,SchwitzerJA,et al.Amputation versus free flap: long-term outcomes of microsurgical limb salvage and risk factors for amputation in the diabetic population[J].Plast Reconstr Surg,2021,147(3):742-750.DOI: 10.1097/PRS.0000000000007644.
[8]	莫小金, 常树森, 魏在荣, 等. 显微削薄胸背动脉穿支皮瓣修复糖尿病足溃疡的临床应用 [J]. 中国修复重建外科杂志, 2022, 36(10): 1266-1272.DOI: 10.7507/1002-1892.202201037.
[9]	蒋玲丽,李海,魏在荣,等.股前外侧嵌合穿支皮瓣修复糖尿病足溃疡创面[J].中华显微外科杂志,2021,44(2):141-145.DOI: 10.3760/cma.j.cn441206-20200813-00320.
[10]	HahnHM,JeongKS,ParkMC,et al.Free-flap transfer for coverage of transmetatarsal amputation stump to preserve residual foot length[J].Int J Low Extrem Wounds,2017,16(1):60-65.DOI: 10.1177/1534734616689508.
[11]	KwonJG,ChoMJ,PakCJ,et al.A retrospective case series on free flap reconstruction for ischemic diabetic foot: the nutrient flap further explained[J].Plast Reconstr Surg,2022,149(6):1452-1461.DOI: 10.1097/PRS.0000000000009132.
[12]	ThaiDQ,LeeDH,LeeWB,et al.What is the impact of infrapopliteal endovascular intervention on free flap survival in diabetic foot reconstruction?[J].J Orthop Surg Res,2021,16(1):42.DOI: 10.1186/s13018-020-02173-9.
[13]	LuJ,DeFazioMV,LakhianiC,et al.Limb salvage and functional outcomes following free tissue transfer for the treatment of recalcitrant diabetic foot ulcers[J].J Reconstr Microsurg,2019,35(2):117-123.DOI: 10.1055/s-0038-1667363.
[14]	ThaiDQ,JungYK,HahnHM,et al.Factors affecting the outcome of lower extremity osteomyelitis treated with microvascular free flaps: an analysis of 65 patients[J].J Orthop Surg Res,2021,16(1):535.DOI: 10.1186/s13018-021-02686-x.
[15]	OuCY,WuMS,LinMC,et al.Short-term and long-term outcomes of free flap reconstruction versus amputation for diabetic foot reconstruction in patients with end-stage renal disease[J].J Plast Reconstr Aesthet Surg,2022,75(8):2511-2519.DOI: 10.1016/j.bjps.2022.04.024.
[16]	《多学科合作下糖尿病足防治专家共识(2020版)》编写组.多学科合作下糖尿病足防治专家共识(2020版)全版[J].中华烧伤杂志,2020,36(8):E01-E52.DOI: 10.3760/cma.j.cn501120-20200217-01000.
[17]	KimHB,AltiparmakM,PakCJ,et al.Reconstruction using free flaps for diabetic heel defects: outcomes and risk factor analysis[J].J Reconstr Microsurg,2020,36(7):494-500.DOI: 10.1055/s-0040-1709477.
[18]	LiuC,YouJX,ChenYX,et al.Effect of induced membrane formation followed by polymethylmethacrylate implantation on diabetic foot ulcer healing when revascularization is not feasible[J].J Diabetes Res,2019,2019:2429136.DOI: 10.1155/2019/2429136.
[19]	黄红军,牛希华,杨冠龙,等.抗生素骨水泥在糖尿病足溃疡创面应用的临床效果[J].中华烧伤杂志,2019,35(6):464-466.DOI: 10.3760/cma.j.issn.1009-2587.2019.06.013.
[20]	JiS,LiuX,HuangJ,et al.Consensus on the application of negative pressure wound therapy of diabetic foot wounds[J/OL].Burns Trauma,2021,9:tkab018[2022-12-26].https://pubmed.ncbi.nlm.nih.gov/34212064/.DOI: 10.1093/burnst/tkab018.
[21]	DuttaA,BhansaliA,RastogiA.Early and intensive glycemic control for diabetic foot ulcer healing: a prospective observational nested cohort study[J].Int J Low Extrem Wounds,2021:15347346211033458.DOI: 10.1177/15347346211033458.
[22]	HasanR,FirwanaB,ElraiyahT,et al.A systematic review and meta-analysis of glycemic control for the prevention of diabetic foot syndrome[J].J Vasc Surg,2016,63(2 Suppl):S22-28.e1-2.DOI: 10.1016/j.jvs.2015.10.005.
[23]	ChengP,DongY,HuZ,et al.Biomarker prediction of postoperative healing of diabetic foot ulcers: a retrospective observational study of serum albumin[J].J Wound Ostomy Continence Nurs,2021,48(4):339-344.DOI: 10.1097/WON.0000000000000780.
[24]	American Diabetes Association.11. Microvascular complications and foot care: standards of medical care in diabetes-2021 [J]. Diabetes Care, 2021, 44(Suppl 1): S151-167.DOI: 10.2337/dc21-S011.
[25]	ForsytheRO,BrownriggJ,HinchliffeRJ.Peripheral arterial disease and revascularization of the diabetic foot[J].Diabetes Obes Metab,2015,17(5):435-444.DOI: 10.1111/dom.12422.
[26]	SuhHP,ParkCJ,HongJP.Special considerations for diabetic foot reconstruction[J].J Reconstr Microsurg,2021,37(1):12-16.DOI: 10.1055/s-0040-1714431.
[27]	JanhoferDE,LakhianiC,KimPJ,et al.The utility of preoperative arteriography for free flap planning in patients with chronic lower extremity wounds[J].Plast Reconstr Surg,2019,143(2):604-613.DOI: 10.1097/PRS.0000000000005265.
[28]	AbdelfattahU,PowerHA,SongS,et al.Algorithm for free perforator flap selection in lower extremity reconstruction based on 563 cases[J].Plast Reconstr Surg,2019,144(5):1202-1213.DOI: 10.1097/PRS.0000000000006167.
[29]	李小兵,刘洪均,杨超,等.带阔筋膜游离股前外侧皮瓣修复糖尿病足溃疡伴骨外露[J].中国修复重建外科杂志,2022,36(1):86-91.DOI: 10.7507/1002-1892.202108110.
[30]	SchirmerS,RitterRG,FansaH.Vascular surgery, microsurgery and supramicrosurgery for treatment of chronic diabetic foot ulcers to prevent amputations[J].PLoS One,2013,8(9):e74704.DOI: 10.1371/journal.pone.0074704.
[31]	ChangLS,JangDW,KimYH,et al.Diabetic foot resurfacing using microvascular tissue transfer from lateral thoracic region[J].Diabetes Metab Res Rev,2023,39(2):e3593.DOI: 10.1002/dmrr.3593.
[32]	SungIH,JangDW,KimSW,et al.Reconstruction of diabetic lower leg and foot soft tissue defects using thoracodorsal artery perforator chimeric flaps[J].Microsurgery,2018,38(6):674-681.DOI: 10.1002/micr.30314.
[33]	KimSW,SungIH,KimYH.Reconstruction of severe atherosclerotic and obstructive diabetic feet using thoracodorsal artery perforator flaps with long vascular pedicles[J].Microsurgery,2018,38(3):287-294.DOI: 10.1002/micr.30251.
[34]	Mayr-RiedlerMS,WackerA,GedrichF,et al.Outcomes and risk factors in microsurgical forefoot reconstruction[J/OL].J Reconstr Microsurg,2022(2022-11-14)[2022-12-16]. https://pubmed.ncbi.nlm.nih.gov/36075381/.DOI:10.1055/a-1939-5742. [published online ahead of print].
[35]	BlackC,FanKL,DefazioMV,et al.Limb salvage rates and functional outcomes using a longitudinal slit arteriotomy end-to-side anastomosis for limb-threatening defects in a high-risk patient population[J].Plast Reconstr Surg,2020,145(5):1302-1312.DOI: 10.1097/PRS.0000000000006791.
[36]	ZhuZ,WangX,HuangJ,et al.Mechanical versus hand-sewn venous anastomoses in free flap reconstruction: a systematic review and meta-analysis[J].Plast Reconstr Surg,2018,141(5):1272-1281.DOI: 10.1097/PRS.0000000000004306.
[37]	KallioM,VikatmaaP,KantonenI,et al.Strategies for free flap transfer and revascularisation with long-term outcome in the treatment of large diabetic foot lesions[J].Eur J Vasc Endovasc Surg,2015,50(2):223-230.DOI: 10.1016/j.ejvs.2015.04.004.
[38]	ArmstrongDG,BoultonA,BusSA.Diabetic foot ulcers and their recurrence[J].N Engl J Med,2017,376(24):2367-2375.DOI: 10.1056/NEJMra1615439.