游离皮瓣在糖尿病足溃疡患者保肢治疗中的应用研究进展

刘欣; 黄广涛; 吴军

doi:10.3760/cma.j.cn501225-20240130-00041

游离皮瓣在糖尿病足溃疡患者保肢治疗中的应用研究进展

doi: 10.3760/cma.j.cn501225-20240130-00041

深圳市第二人民医院（深圳大学第一附属医院）烧伤整形创面修复科,深圳　　518035

基金项目:

河套创新合作区项目 HTHZQSWS-KCCYB-2023060

国家自然科学基金面上项目 82172214, 82472545

详细信息

通讯作者:
吴军,Email：junwupro@126.com

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- 被引次数: 0
出版历程
- 收稿日期: 2024-01-30
- 网络出版日期: 2024-10-28

Research advances on the application of free flaps in limb salvage treatment of patients with diabetic foot ulcers

Department of Burns and Plastic Surgery, Department of Wound Repair, the First Affiliated Hospital of Shenzhen University, Shenzhen 518035, China

Funds:

Shenzhen Portion of Shenzhen-Hong Kong Science and Technology Innovation Cooperation Zone Project HTHZQSWS-KCCYB-2023060

General Program of National Natural Science Foundation of China 82172214, 82472545

More Information

Corresponding author: Wu Jun, Email: junwupro@126.com

摘要

摘要: 糖尿病足溃疡（DFU）是糖尿病的严重并发症之一,治疗难度大、截肢风险高。目前指南建议,根据DFU中组织坏死程度及血管闭塞平面、患者年龄及全身脏器功能综合评估截肢平面。然而,截肢后的DFU患者生存率及生活质量均受到较大影响。通过查阅国内外文献并对DFU保肢治疗的经验进行总结,该团队认为采用游离皮瓣移植进行保肢治疗,对于部分严重DFU患者而言意义重大。此外,该文还重点分析了DFU患者接受游离皮瓣移植手术的适应证和围手术期注意事项。
- 糖尿病足 /
- 溃疡 /
- 外科皮瓣 /
- 保肢治疗 /
- 创面修复
Abstract: Diabetic foot ulcers (DFUs) is one of the severe complications of diabetes, which is difficult to treat and associated with a high risk of amputation. Current guidelines recommend that the plane of amputation be comprehensively assessed based on the degree of tissue necrosis and plane of vascular occlusion in DFUs, the age and systemic organ function of patients. However, the survival and quality of life of DFU patients suffering from amputation will be significantly affected. After reviewing the national and international literature and summarizing the experience of limb-salvage treatment of DFUs, we believe that free flap transplantation is of great significance for limb-salvage treatment to some patients with severe DFUs. In addition, this article also focus on analyzing the indications and perioperative precautions for patients with DFUs undergoing free flap transplantation.
- Diabetic foot /
- Ulcer /
- Surgical flaps /
- Limb salvage /
- Wound repair
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参考文献(52)

[1]	SunH, SaeediP, KarurangaS, et al. IDF diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045[J]. Diabetes Res Clin Pract, 2022,183:109119. DOI: 10.1016/j.diabres.2021.109119.
[2]	SkrepnekGH, SrMJL, LaveryLA, et al. Health care service and outcomes among an estimated 6.7 million ambulatory care diabetic foot cases in the U.S[J]. Diabetes Care, 2017,40(7):936-942. DOI: 10.2337/dc16-2189.
[3]	van NettenJJ, BusSA, ApelqvistJ, et al. Definitions and criteria for diabetic foot disease[J]. Diabetes Metab Res Rev, 2020,36Suppl 1:Se3268. DOI: 10.1002/dmrr.3268.
[4]	ArmstrongDG, TanTW, BoultonA, et al. Diabetic foot ulcers: a review[J]. JAMA, 2023,330(1):62-75. DOI: 10.1001/jama.2023.10578.
[5]	HuX, ZhangY, ChenY, et al. Validation and application of the 2019 International Working Group on the Diabetic Foot risk stratification for diabetic foot in Chinese patients[J]. J Diabetes Investig, 2023,14(7):893-901. DOI: 10.1111/jdi.14014.
[6]	KuguyoO, MukonaDM, ChikwashaV, et al. Prevalence and risk factors for diabetic foot complications among people living with diabetes in Harare, Zimbabwe: a cross-sectional study[J]. BMC Public Health, 2024,24(1):677. DOI: 10.1186/s12889-023-17610-7.
[7]	ChenL, SunS, GaoY, et al. Global mortality of diabetic foot ulcer: a systematic review and meta-analysis of observational studies[J]. Diabetes Obes Metab, 2023,25(1):36-45. DOI: 10.1111/dom.14840.
[8]	LinCW, ArmstrongDG, HuangCH, et al. Diabetic foot disease in subjects with End-stage renal Disease: a nationwide study over 14 years highlighting an emerging threat[J]. Diabetes Res Clin Pract, 2022,193:110134. DOI: 10.1016/j.diabres.2022.110134.
[9]	HarrisRC, FangW. Transmetatarsal amputation outcomes when utilized to address foot gangrene and infection: a retrospective chart review[J]. J Foot Ankle Surg, 2021,60(2):269-275. DOI: 10.1053/j.jfas.2020.08.006.
[10]	YammineK, HayekF, AssiC. A meta-analysis of mortality after minor amputation among patients with diabetes and/or peripheral vascular disease[J]. J Vasc Surg, 2020,72(6):2197-2207. DOI: 10.1016/j.jvs.2020.07.086.
[11]	付记乐小腿创面显微修复的受区血管选择及血管吻合方式的探讨广州南方医科大学2020 付记乐. 小腿创面显微修复的受区血管选择及血管吻合方式的探讨[D]. 广州:南方医科大学, 2020.
[12]	PouwerF, Mizokami-StoutK, ReevesND, et al. Psychosocial care for people with diabetic neuropathy: time for action[J]. Diabetes Care, 2024,47(1):17-25. DOI: 10.2337/dci23-0033.
[13]	LazzariniPA, CrambSM, GolledgeJ, et al. Global trends in the incidence of hospital admissions for diabetes-related foot disease and amputations: a review of national rates in the 21st century[J]. Diabetologia, 2023,66(2):267-287. DOI: 10.1007/s00125-022-05845-9.
[14]	BekenyJC, ZolperEG, SteinbergJS, et al. Free tissue transfer for patients with chronic lower extremity wounds[J]. Clin Plast Surg, 2021,48(2):321-329. DOI: 10.1016/j.cps.2021.01.004.
[15]	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.
[16]	OrrapinS, SiribumrungwongB. Successful revascularization, angiosome concept, and multivessel revascularization: effects on wound healing: an asian perspective[J]. Int J Low Extrem Wounds, 2024,23(1):12-18. DOI: 10.1177/15347346231212330.
[17]	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.
[18]	BhatS, ChiaB, BarryIP, et al. Free tissue transfer in diabetic foot ulcers: a systematic review and meta-analysis[J]. Eur J Vasc Endovasc Surg, 2023,66(5):670-677. DOI: 10.1016/j.ejvs.2023.07.031.
[19]	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.
[20]	GolledgeJ. Update on the pathophysiology and medical treatment of peripheral artery disease[J]. Nat Rev Cardiol, 2022,19(7):456-474. DOI: 10.1038/s41569-021-00663-9.
[21]	FoussardN, DariL, DucasseE, et al. Lower-limb peripheral arterial disease and amputations in people with diabetes: risk factors, prognostic value and management[J]. Presse Med, 2023,52(1):104164. DOI: 10.1016/j.lpm.2023.104164.
[22]	ShishehborMH, PowellRJ, Montero-BakerMF, et al. Transcatheter arterialization of deep veins in chronic limb-threatening ischemia[J]. N Engl J Med, 2023,388(13):1171-1180. DOI: 10.1056/NEJMoa2212754.
[23]	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.
[24]	HoulindK. Surgical revascularization and reconstruction procedures in diabetic foot ulceration[J]. Diabetes Metab Res Rev, 2020,36Suppl 1:Se3256. DOI: 10.1002/dmrr.3256.
[25]	SuhHP, ParkCJ, HongJP. Special considerations for diabetic foot reconstruction[J]. J Reconstr Microsurg, 2021,37(1):12-16. DOI: 10.1055/s-0040-1714431.
[26]	FitridgeR, ChuterV, MillsJ, et al. The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes and a foot ulcer[J]. Diabetes Metab Res Rev, 2024,40(3):e3686. DOI: 10.1002/dmrr.3686.
[27]	VenermoM, BiancariF, ArvelaE, et al. The role of chronic kidney disease as a predictor of outcome after revascularisation of the ulcerated diabetic foot[J]. Diabetologia, 2011,54(12):2971-2977. DOI: 10.1007/s00125-011-2279-1.
[28]	ArmstrongDG, SwerdlowMA, ArmstrongAA, et al. Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer[J]. J Foot Ankle Res, 2020,13(1):16. DOI: 10.1186/s13047-020-00383-2.
[29]	ChienSH, HuangCC, HsuH, et al. Free tissue transfers for limb salvage in patients with end-stage renal disease on dialysis[J]. Plast Reconstr Surg, 2011,127(3):1222-1228. DOI: 10.1097/PRS.0b013e318205f461.
[30]	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.
[31]	SchaperNC, van NettenJJ, ApelqvistJ, et al. Practical guidelines on the prevention and management of diabetes-related foot disease (IWGDF 2023 update)[J]. Diabetes Metab Res Rev, 2024,40(3):e3657. DOI: 10.1002/dmrr.3657.
[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]	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.
[34]	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.
[35]	KimSW, YounDH, HwangKT, et al. Reconstruction of the lateral malleolus and calcaneus region using free thoracodorsal artery perforator flaps[J]. Microsurgery, 2016,36(3):198-205. DOI: 10.1002/micr.22389.
[36]	SennevilleÉ, AlbalawiZ, van AstenSA, et al. IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes-related foot infections (IWGDF/IDSA 2023)[J]. Clin Infect Dis, 2023:ciad527. DOI: 10.1093/cid/ciad527.
[37]	ChangS, JianY, LiuC, et al. Combining antibiotic-loaded bone cement-based free vastus lateralis muscle-sparing flap with split-thickness skin grafts: a reliable strategy for reconstructing diabetic foot ulcers at non-weight-bearing areas[J]. Int Wound J, 2024,21(5):e14900. DOI: 10.1111/iwj.14900.
[38]	JigaLP, JandaliZ, MerwartB, et al. The free vastus lateralis muscle flap. A smart less used flap for soft tissue reconstruction of the weight-bearing foot[J]. Injury, 2020,51Suppl 4:S34-40. DOI: 10.1016/j.injury.2020.03.019.
[39]	JinkaS, JinkaA, JanisJE. Lower extremity reconstruction with anterolateral thigh free-flap anastomoses: a computational fluid dynamic analysis[J]. J Reconstr Microsurg, 2024,40(1):12-22. DOI: 10.1055/a-2056-0629.
[40]	OhtaM, IkedaM, TogoT, et al. Limb salvage of infected diabetic foot ulcers with free deep inferior epigastric perforator flaps[J]. Microsurgery, 2006,26(2):87-92. DOI: 10.1002/micr.20180.
[41]	RandonC, VermassenF, JacobsB, et al. Outcome of arterial reconstruction and free-flap coverage in diabetic foot ulcers: long-term results[J]. World J Surg, 2010,34(1):177-184. DOI: 10.1007/s00268-009-0250-9.
[42]	SalibianAA, SwerdlowMA, KondraK, et al. Extreme limb salvage: the thin SCIP flap for distal amputation coverage in highly comorbid patients[J]. Plast Reconstr Surg, 2024,154(2):440-449. DOI: 10.1097/PRS.0000000000011030.
[43]	OzkanO, CoşkunfiratOK, OzgentaşHE. Reliability of free-flap coverage in diabetic foot ulcers[J]. Microsurgery, 2005,25(2):107-112. DOI: 10.1002/micr.20094.
[44]	LipskyBA, SennevilleÉ, AbbasZG, et al. Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)[J]. Diabetes Metab Res Rev, 2020,36Suppl 1:Se3280. DOI: 10.1002/dmrr.3280.
[45]	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.
[46]	陈伟, 常树森, 周健, 等. 抗生素骨水泥联合游离股前外侧组织瓣序贯治疗糖尿病足溃疡的临床疗效[J].中华烧伤与创面修复杂志,2023,39(4):319-324. DOI: 10.3760/cma.j.cn501225-20220628-00267.
[47]	TcheroH, KangambegaP, NoubouL, et al. Antibiotic therapy of diabetic foot infections: a systematic review of randomized controlled trials[J]. Wound Repair Regen, 2018,26(5):381-391. DOI: 10.1111/wrr.12649.
[48]	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.
[49]	ChenP, VilorioNC, DhatariyaK, et al. Guidelines on interventions to enhance healing of foot ulcers in people with diabetes (IWGDF 2023 update)[J]. Diabetes Metab Res Rev, 2024,40(3):e3644. DOI: 10.1002/dmrr.3644.
[50]	RuderK. Diabetic foot infections and amputations are all too common-here's what could move the needle[J]. JAMA, 2024,331(12):998-1000. DOI: 10.1001/jama.2024.1016.
[51]	简扬, 魏在荣, 陈伟, 等. 游离皮瓣在糖尿病足溃疡修复中的应用研究进展[J].中华烧伤与创面修复杂志, 2023, 39(4): 376-380. DOI: 10.3760/cma.j.cn501225-20221216-00539.
[52]	刘陈肖笑, 简扬, 张演基, 等. 基于抗生素骨水泥的糖尿病足溃疡治疗策略研究进展[J].组织工程与重建外科杂志,2023,19(6):591-596. DOI: 10.3969/j.issn.1673-0364.2023.06.014.