Email Alerts
RSS
Volume 38 Issue 12
Dec.  2022
Turn off MathJax
Article Contents
Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2022  >  38(12): 1148-1155
Yang Li, Li Kelin, Pang Yuanxiang, et al. Clinical effects of free descending branch tissue flap of lateral circumflex femoral artery in repairing Wagner grade 3 or 4 diabetic foot wounds[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2022, 38(12): 1148-1155. Doi: 10.3760/cma.j.cn501225-20220321-00076
Citation: Yang Li, Li Kelin, Pang Yuanxiang, et al. Clinical effects of free descending branch tissue flap of lateral circumflex femoral artery in repairing Wagner grade 3 or 4 diabetic foot wounds[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2022, 38(12): 1148-1155. Doi: 10.3760/cma.j.cn501225-20220321-00076
shu

Clinical effects of free descending branch tissue flap of lateral circumflex femoral artery in repairing Wagner grade 3 or 4 diabetic foot wounds

doi: 10.3760/cma.j.cn501225-20220321-00076

  • Department of Burns, Plastic and Reconstructive Surgery, the First People's Hospital of Yulin, Yulin 537000, China

Funds:

Science and Technology Project of Health and Family Planning Commission of Guangxi Zhuang Autonomous Region of China Z20180993

More Information
  • Corresponding author: Li Kelin, Email: 285262145@qq.com
  • Received Date: 2022-03-21
    Abstract
  •   Objective  To investigate the clinical effects of free descending branch tissue flap of lateral circumflex femoral artery in repairing Wagner grade 3 or 4 diabetic foot wounds.  Methods  A retrospective observational study was conducted. From October 2019 to January 2022, 12 patients (10 males and 2 females, aged 38-66 years, with an average of 52 years) with diabetic foot wounds who met the inclusion criteria were admitted to the First People's Hospital of Yulin, of whom 5 cases being Wagner grade 3 and 7 cases being Wagner grade 4. Wound debridement and vacuum sealing drainage were performed to control infection, and the wound area after debridement was between 13 cm×6 cm and 28 cm×11 cm. The wounds were repaired with free descending branch tissue flaps of lateral circumflex femoral artery. Among them, the wounds of 4 cases were repaired with single flap of musculocutaneous branch or intermuscular branch of descending branch tissue flap of lateral circumflex femoral artery, 1 case with lobulated flap, 1 case with bilateral tandem flap, and 6 cases with chimeric lateral femoral muscle flap. The area of resected tissue flap was 9 cm×7 cm to 21 cm×10 cm; end-to-end anastomosis was selected between vessels in the donor sites and the recipient sites, and pressurized treatment should be performed if necessary. The donor site wounds of 10 patients were treated with cosmetic tension-relieving suture, and the donor site wounds of 2 patients were repaired with split-thickness skin graft from head. After operation, the condition of wound repair was recorded. After wound healing, the level of 2-hour postprandial blood glucose of patients was measured. During follow-up, the wound healing of the recipient site and scar formation of the donor site were observed. Before and 6 months after operation, computer tomography angiography was used to detect and compare the blood perfusion of the affected limb. At the last follow-up, the walking ability of the patients was recorded.  Results  The wounds of 9 patients healed well after operation; the flaps in the recipient site of 2 patients were infected on postoperative day 5 after surgery and were repaired by suturing in stage Ⅱ after open drainage and inflammation control; the distal end of the grafted tandem flap in 1 patient gradually developed purple necrosis on postoperative day 4 and was repaired with a skin graft after debridement. After wound healing, the 2-hour postprandial blood glucose value of all patients was controlled in the range of 8-12 mmol/L. During Follow-up of 6 months to 1 year, 3 patients had partial ulceration in the plantar compression area, which healed after decompression combined with dressing change or flap repair, while the other 9 patients had no ulceration in the recipient area; the appearance of the affected foot was plump after wound healing, the transplanted flaps had good blood supply and good fit with the surrounding tissue, and were wear-resistant, but insensitive. During follow-up, only linear scar remained in the donor area of direct suture in 10 cases, and the skin grafts in the donor area were completely survived in 2 cases. Compared with the patency of the main blood vessels of the ankle joint segment of the affected limb before operation, the vascular network of the flap transplantation area in the affected foot was formed 6 months after operation. At the last follow-up, 8 patients could walk independently, and 4 patients could walk with crutches.  Conclusions  The free descending branch tissue flap of lateral circumflex femoral artery is effective in repairing Wagner grade 3 or 4 diabetic foot wounds, which can shorten the course of disease and improve local blood flow.

     

    • FullText(HTML)
  • loading
    • References(36)
  • [1]
    黄瑶,钱培芬.糖尿病足分级系统及其评价[J].中华烧伤杂志,2012,28(1):47-50.DOI: 10.3760/cma.j.issn.1009-2587.2012.01.011.
    [2]
    刘冰峰,谢举临,彭文要,等.糖尿病足保肢性治疗方法探讨[J/CD].中华损伤与修复杂志:电子版,2015,10(5):40-42.DOI: 10.3877/cma.j.issn.1673-9450.2015.05.009.
    [3]
    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.
    [4]
    ChenX,WuM,HuQ,et al.Incidence and risk factors for poor perioperative blood glucose management in patients with diabetic foot: a retrospective study[J].Ann Palliat Med,2021,10(12):12300-12309.DOI: 10.21037/apm-21-3095.
    [5]
    罗文静,李欣仪,赵楠,等.糖尿病足分级系统临床应用进展[J].感染、炎症、修复，2020,21(2):115-118.DOI: 10.3969/j.issn.1672-8521.2020.02.012.
    [6]
    徐波,杨彩哲,吴石白,等.糖尿病足患者截肢相关危险因素分析[J].中华内科杂志,2017,56(1):24-28.DOI: 10.3760/cma.j.issn.0578-1426.2017.01.007.
    [7]
    中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(1):4-67.DOI: 10.3760/cma.j.issn.1674-5809.2018.01.003.
    [8]
    XieP,DengB,ZhangX,et al.Time in range in relation to amputation and all-cause mortality in hospitalised patients with diabetic foot ulcers[J].Diabetes Metab Res Rev,2022,38(2):e3498.DOI: 10.1002/dmrr.3498.
    [9]
    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.
    [10]
    ChangCH,HuangCC,HsuH,et al.Editor's choice-diabetic limb salvage with endovascular revascularisation and free tissue transfer: long-term follow up[J].Eur J Vasc Endovasc Surg,2019,57(4):527-536.DOI: 10.1016/j.ejvs.2018.11.010.
    [11]
    谭斌,王振林,李登博,等.抗生素骨水泥封闭创面诱导膜植皮修复肌腱外露创面[J].中国骨伤,2020,33(6):564-566.DOI: 10.12200/j.issn.1003-0034.2020.06.015.
    [12]
    张展,张春,郭峭峰.应用股骨剔骨皮瓣治疗复杂性褥疮九例[J].中华显微外科杂志,2016,39(6):588-590.DOI: 10.3760/cma.j.issn.1001-2036.2016.06.021.
    [13]
    黄平,余晓芳,尤加锐,等.抗生素骨水泥联合延迟外踝上穿支筋膜皮瓣治疗糖尿病足[J].中华显微外科杂志,2022,45(2):128-132.DOI: 10.3760/cma.j.cn441206-20211201-00284.
    [14]
    LeeJT,ChengLF,HsuH,et al.Reconstruction of diabetic foot defects with the proximal lateral leg perforator flap[J].Ann Plast Surg,2019,82(5):546-551.DOI: 10.1097/SAP.0000000000001745.
    [15]
    黄凯,郭峭峰,沈立锋,等.小腿糖尿病性溃疡的外科治疗[J].中华内分泌外科杂志,2017,11(3):207-209,214.DOI: 10.3760/cma.j.issn.1674-6090.2017.03.008.
    [16]
    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.
    [17]
    EskelinenE,KaartinenI,KääriäinenM,et al.Successful foot salvage with microvascular flaps in diabetic patients[J].Scand J Surg,2015,104(2):103-107.DOI: 10.1177/1457496914524389.
    [18]
    ShyamsundarS,MahmudAA,KhalasiV.The gracilis muscle flap: a "work horse" free flap in diabetic foot reconstruction[J].World J Plast Surg,2021,10(2):33-39.DOI: 10.29252/wjps.10.2.33.
    [19]
    SatoT,YanaY,IchiokaS.Free flap reconstruction for diabetic foot limb salvage[J].J Plast Surg Hand Surg,2017,51(6):399-404.DOI: 10.1080/2000656X.2017.1285782.
    [20]
    SmithRK,WykesJ,MartinDT,et al.Perforator variability in the anterolateral thigh free flap: a systematic review[J].Surg Radiol Anat,2017,39(7):779-789.DOI: 10.1007/s00276-016-1802-y.
    [21]
    唐举玉,贺继强,吴攀峰,等.股前外侧分叶-嵌合穿支皮瓣在四肢复杂创伤修复中的应用[J].中华显微外科杂志,2020,43(4):326-330.DOI: 10.3760/cma.j.cn441206-20190309-00089.
    [22]
    MotomiyaM,WatanabeN,NakamuraS,et al.Blood flow distribution after end-to-side anastomosis with wide arteriotomy in extremity free flap surgery[J].J Plast Reconstr Aesthet Surg,2021,74(10):2495-2503.DOI: 10.1016/j.bjps.2021.03.022.
    [23]
    刘小俊,王志学,苏建东,等.股前外侧薄皮瓣在修复重建外科的应用进展[J].中国临床解剖学杂志,2019,37(1):110-112.DOI: 10.13418/j.issn.1001-165x.2019.01.023.
    [24]
    王玉珍,许樟荣,胡成玮.糖尿病足患者的临床特点及住院费用分析[J].中华老年多器官疾病杂志,2003,2(4):271-274.DOI: 10.3969/j.issn.1671-5403.2003.04.012.
    [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]
    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.
    [27]
    KimJY, LeeYJ. A study of the survival factors of free flap in older diabetic patients[J]. J Reconstr Microsurg,2007,23(7):373-380. DOI: 10.1055/s-2007-992345.
    [28]
    TreiserMD,MilesMR,AlbinoFP,et al.Long-term patency and fluid dynamics of recipient artery after end-to-side anastomosis for free tissue transfer[J].Plast Reconstr Surg,2021,148(5):800e-803e.DOI: 10.1097/PRS.0000000000008439.
    [29]
    GeierlehnerA,RodiT,MosahebiA,et al.Meta-analysis of venous anastomosis techniques in free flap reconstruction[J].J Plast Reconstr Aesthet Surg,2020,73(3):409-420.DOI: 10.1016/j.bjps.2019.11.033.
    [30]
    AhmadiI,HerleP,MillerG,et al.End-to-end versus end-to-side microvascular anastomosis: a meta-analysis of free flap outcomes[J].J Reconstr Microsurg,2017,33(6):402-411.DOI: 10.1055/s-0037-1599099.
    [31]
    ZhanY,FuG,ZhouX,et al.Emergency repair of upper extremity large soft tissue and vascular injuries with flow-through anterolateral thigh free flaps[J].Int J Surg,2017,48:53-58.DOI: 10.1016/j.ijsu.2017.09.078.
    [32]
    TurinSY,WaltonRL,DumanianGA,et al.Current practices in the management of postoperative arterial vasospasm in microsurgery[J].J Reconstr Microsurg,2018,34(4):242-249.DOI: 10.1055/s-0037-1612601.
    [33]
    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.
    [34]
    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.
    [35]
    赵建军,谢振军,张会峰,等.游离股前外侧穿支皮瓣在修复糖尿病足溃疡骨外露中的应用[J].中华内分泌外科杂志,2021,15(3):221-224.DOI: 10.3760/cma.j.cn.115807-20200325-00091.
    [36]
    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.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(4)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (2294) PDF downloads(85) Cited by()
    Proportional views
    Related

    Copyright © Chinese Journal of Burns京ICP备07035254号-14

    E-mail：shaoshangzazhi@163.com

    Website：https://zhsszz.xml-journal.net/

    Supported by: Beijing Renhe Information Technology Co. Ltd    

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return