Volume 40 Issue 8
Aug.  2024
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Zhao JJ,Xie ZJ,Zhao GH,et al.Clinical effects of free anterolateral thigh perforator flaps in repairing diabetic foot ulcers under a multi-disciplinary team cooperation model[J].Chin J Burns Wounds,2024,40(8):756-761.DOI: 10.3760/cma.j.cn501225-20231107-00184.
Citation: Zhao JJ,Xie ZJ,Zhao GH,et al.Clinical effects of free anterolateral thigh perforator flaps in repairing diabetic foot ulcers under a multi-disciplinary team cooperation model[J].Chin J Burns Wounds,2024,40(8):756-761.DOI: 10.3760/cma.j.cn501225-20231107-00184.

Clinical effects of free anterolateral thigh perforator flaps in repairing diabetic foot ulcers under a multi-disciplinary team cooperation model

doi: 10.3760/cma.j.cn501225-20231107-00184
Funds:

Science and Technology Research Project of Henan Province of China 242102311085

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  • Corresponding author: Xie Zhenjun, Email: xzj65@126.com
  • Received Date: 2023-11-07
  •   Objective  To explore the clinical effects of free anterolateral thigh perforator flaps in repairing diabetic foot ulcers (DFUs) under a multi-disciplinary team (MDT) cooperation model.  Methods  The study was a retrospective observational study. From June 2018 to December 2022, 49 DFU patients who met the inclusion criteria were admitted to the Department of Hand and Foot Microscopy and Wound Repair Surgery of Henan Provincial People's Hospital (People's Hospital of Zhengzhou University), including 28 males and 21 females, aged from 47 to 68 years, with type 2 diabetes history period ranging from 6 months to 21 years. Under a MDT cooperation model, the physicians from department of endocrinology comprehensively assessed the patients, stabilized the patients' general condition, and controlled their complications, the surgeons from department of vascular surgery assessed and improved the patients' lower limb blood supply, the physicians from department of infectious diseases provided anti-infection treatment plans, the physicians from department of anesthesiology and perioperative medicine assessed the patients' perioperative risk and ensured their perioperative safety, and according to the patients' condition, the physicians from departments such as cardiology, neurology, nutrition, and rehabilitation actively and timely participated in the treatment. The surgeons from department of hand and foot microscopy and wound repair surgery prepared the wound base and used free anterolateral thigh perforator flaps to repair the wounds. After once or multiple debridement in the first stage, the wound area ranged from 5.0 cm×4.5 cm to 17.0 cm×10.0 cm. After once or twice vacuum sealing drainage treatment, the free anterolateral thigh perforator flaps were used to repair the wounds with incision area of 6 cm×5 cm to 18 cm×11 cm in the second stage. The descending branches of lateral circumflex femoral artery and the accompanying veins of flaps were anastomosed to the arteries and veins in the recipient sites, respectively. The wounds in the flap donor sites were sutured directly. After surgery, whether the patient's perioperative period was stable, the survival of flaps, the healing of wounds in the flap donor and recipient sites were observed. During the follow-up, the texture and appearance of flaps, whether there was a new ulcer, and the patient's walking ability were observed.  Results  All the patients had stable perioperative period. Among them, the flaps in 46 patients survived successfully; the flaps in 2 patients developed complete necrosis, including 1 case whose ulcer was healed after repair of pedicled flap from the lower leg, and 1 case who underwent amputation of the lower leg; the flap in 1 patient developed partial necrosis, which was healed after dressing change and skin grafting. The wounds in the flap donor and recipient sites healed well. During the postoperative follow-up of 6-24 months, the flaps had good texture and appearance with no new ulcers, and the patients had no obvious impairment in daily walk.  Conclusions  The MDT cooperation model can sufficiently ensure the perioperative safety of DFU patients. The free anterolateral thigh perforator flaps can repair the DFU wounds achieving good clinical effects with high flap survival rate and decreased amputation rate.

     

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  • [1]
    中华医学会糖尿病学分会,中华医学会感染病学分会,中华医学会组织修复与再生分会.中国糖尿病足防治指南(2019版)(Ⅴ)[J].中华糖尿病杂志,2019,11(6):387-397. DOI: 10.3760/cma.j.issn.1674-5809.2019.06.005.
    [2]
    WangAP,LvGZ,ChengXB,et al.Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease (2020 edition)[J/OL].Burns Trauma,2020,8:tkaa017[2023-11-07].https://pubmed.ncbi.nlm.nih.gov/32685563/.DOI: 10.1093/burnst/tkaa017.
    [3]
    《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.
    [4]
    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.
    [5]
    GazzarusoC,GallottiP,PujiaA,et al.Predictors of healing, ulcer recurrence and persistence, amputation and mortality in type 2 diabetic patients with diabetic foot: a 10-year retrospective cohort study[J].Endocrine,2021,71(1):59-68.DOI: 10.1007/s12020-020-02431-0.
    [6]
    WagnerFWJr.The dysvascular foot: a system for diagnosis and treatment[J].Foot Ankle,1981,2(2):64-122.DOI: 10.1177/107110078100200202.
    [7]
    郭晓峰,邓鑫鑫,黄治虎,等.带蒂皮瓣联合膜诱导技术修复糖尿病患者足踝部创面的效果[J].中华烧伤与创面修复杂志,2023,39(4):325-329.DOI: 10.3760/cma.j.cn501225-20221212-00534.
    [8]
    龙露瑶,陈燕微,邓如非,等.延迟腓肠神经营养血管皮瓣在糖尿病足溃疡中的应用与研究进展[J].中华烧伤与创面修复杂志,2024,40(3):296-300.DOI: 10.3760/cma.j.cn501225-20231102-00173.
    [9]
    贾伟平.中国糖尿病防治的战略思考及体系建设的创新实践[J].中华内科杂志,2019,58(1):1-4.DOI: 10.3760/cma.j.issn.0578-1426.2019.01.001.
    [10]
    魏在荣,简扬.糖尿病足创面外科治疗模式探讨[J].中华烧伤与创面修复杂志,2023,39(4): 305-310.DOI: 10.3760/cma.j.cn501225-20230213-00044.
    [11]
    唐通军,李丹,曾爱红,等.多学科协作诊疗模式在公立医院行政管理中的探索[J].中华医院管理杂志,2019,35(3):262-264.DOI: 10.3760/cma.j.issn.1000-6672.2019.03.022.
    [12]
    冉兴无.用指南规范医疗行为,进一步降低我国糖尿病足的截肢率[J].中华糖尿病杂志,2019,11(2):81-82.DOI: 10.3760/cma.j.issn.1674-5809.2019.02.001.
    [13]
    Mathoulin-PélissierS,ChevreauC,BelleraC,et al.Adherence to consensus-based diagnosis and treatment guidelines in adult soft-tissue sarcoma patients: a French prospective population-based study[J].Ann Oncol,2014,25(1):225-231.DOI: 10.1093/annonc/mdt407.
    [14]
    PowellHA,BaldwinDR.Multidisciplinary team management in thoracic oncology: more than just a concept?[J].Eur Respir J,2014,43(6):1776-1786. DOI: 10.1183/09031936.00150813.
    [15]
    JiSZ,LiuXB,HuangJ,et al.Consensus on the application of negative pressure wound therapy of diabetic foot wounds[J/OL].Burns Trauma,2021,9:tkab018[2023-11-07].https://pubmed.ncbi.nlm.nih.gov/34212064/.DOI: 10.1093/burnst/tkab018.
    [16]
    海峡两岸医药卫生交流协会烧创伤暨组织修复专委会.负压伤口疗法在糖尿病足创面治疗中的应用全国专家共识(2021版)[J].中华烧伤杂志,2021,37(6):508-518.DOI: 10.3760/cma.j.cn501120-20210107-00010.
    [17]
    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.
    [18]
    赵晨兵,张会峰.载抗生素骨水泥治疗糖尿病足感染创面的研究进展[J].中华糖尿病杂志,2022,14(7):724-729.DOI: 10.3760/cma.j.cn115791-20211213-00660.
    [19]
    曹涛,计鹏,张智,等.抗生素骨水泥治疗糖尿病足溃疡的前瞻性随机对照研究[J].中华烧伤与创面修复杂志,2023,39(4):311-318.DOI: 10.3760/cma.j.cn501225-20221111-00485.
    [20]
    方栋,孙良业,谢肇.载万古霉素骨水泥间隔器治疗跟骨创伤后骨感染的疗效[J].中华创伤杂志,2019,35(2):109-114.DOI: 10.3760/cma.j.issn.1001-8050.2019.02.003.
    [21]
    高磊,石宇,李天博,等.带腓动脉穿支的腓肠神经营养皮瓣在糖尿病足创面修复中的应用[J].中国美容整形外科杂志,2022,33(3):139-142.DOI: 10.3969/j.issn.1673-7040.2022.03.004.
    [22]
    胡长青,连勇,白晓亮,等.游离胸背动脉穿支皮瓣修复小腿远端及足踝部创面九例[J].中华烧伤杂志,2018,34(4):240-242.DOI: 10.3760/cma.j.issn.1009-2587.2018.04.009.
    [23]
    中华医学会显微外科学分会.MBCMA股前外侧皮瓣临床应用指南(2016征求意见稿)[J].中华显微外科杂志,2016,39(4):313-317.DOI: 10.3760/cma.j.issn.1001-2036.2016.04.001.
    [24]
    计鹏,曹涛,张智,等.股前外侧嵌合穿支皮瓣修复足踝部复杂创面的效果[J].中华烧伤与创面修复杂志,2023,39(10):926-932.DOI: 10.3760/cma.j.cn501225-20230627-00232.
    [25]
    李雷,巨积辉,周正虎,等.开槽灌洗序贯Flow-through型股前外侧嵌合肌皮瓣治疗胫骨慢性骨髓炎[J].中华显微外科杂志,2019,42(3):223-227.DOI: 10.3760/cma.j.issn.1001-2036.2019.03.004.
    [26]
    杨力,蔡斌,薛君荣,等.个体化股前外侧皮瓣游离移植修复复杂难愈性创面的临床效果[J].中华烧伤杂志,2020,36(8):730-734.DOI: 10.3760/cma.j.cn501120-20190621-00281.
    [27]
    赵国红,魏鹏飞,孙华伟,等.多叶连体股前外侧穿支皮瓣一期修复手背合并多指指背软组织缺损[J].中华显微外科杂志,2020,43(6):553-557.DOI: 10.3760/cma.j.cn441206-20200428-00219.
    [28]
    钟怡鸣,孙焕伟,陈东,等.携带阔筋膜的股前外侧穿支皮瓣修复头皮及硬脑膜缺损八例[J].中华显微外科杂志,2022,45(5):552-556.DOI: 10.3760/cma.j.cn441206-20220319-00055.
    [29]
    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.
    [30]
    杨力,李科霖,庞远翔,等.游离旋股外侧动脉降支组织瓣修复Wagner 3级或4级糖尿病足创面的临床效果[J].中华烧伤与创面修复杂志,2022,38(12):1148-1155.DOI: 10.3760/cma.j.cn501225-20220321-00076.
    [31]
    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.
    [32]
    任高宏,胡稷杰,裴国献.倒“Y”形血管吻合游离皮瓣移植在肢体创面修复与功能重建中的应用[J].中华显微外科杂志,2012,35(1):27-31,插图1-5.DOI: 10.3760/cma.j.issn.1001-2036.2012.01.012.
    [33]
    刘飞,闫炜琪,马强,等.股前外侧血流桥接嵌合穿支皮瓣游离移植治疗伴主干动脉缺损的上肢复合组织缺损的临床效果[J].中华烧伤与创面修复杂志,2024,40(2):172-179.DOI: 10.3760/cma.j.cn501225-20231103-00176.
    [34]
    柳志锦,巨积辉,周荣,等.带阔筋膜血流桥接型股前外侧穿支皮瓣修复伴伸肌腱缺损的手、足背侧创面[J].中华创伤杂志,2021,37(10):894-899.DOI: 10.3760/cma.j.cn501098-20210326-00204.
    [35]
    刘学光,周建东,陈政,等.股前外侧Flow-through皮瓣联合Masquelet技术在胫骨远端Gustilo ⅢC型骨折急诊保肢中的应用[J].中华显微外科杂志,2024,47(3):261-266.DOI: 10.3760/cma.j.cn441206-20231107-00070.
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