SLR - October 2011 - Matthew J. Hentges

Foot and Ankle Reconstruction: Pedicled Muscle Flaps versus Free Flaps and the Role of Diabetes

Reference: Ducic, I., Attinger, C.E. (2011). Foot and ankle reconstruction: Pedicled muscle flaps versus free flaps and the role of diabetes. Plastic and Reconstructive Surgery, 128(1), 173-180.               

Scientific Literature Review

Reviewed by: Matthew J. Hentges, DPM
Residency Program: The Western Pennsylvania Hospital, Pittsburgh, PA

Podiatric Relevance:
The need for soft tissue coverage of wounds is common in the diabetic patient.  This article analyzes the influence of diabetes mellitus on the results of pedicled muscle flaps versus free flaps for complex foot and ankle reconstruction.

Thirty-eight diabetic patients and 42 nondiabetic patients were identified from the Georgetown Wound Registry from 1990 to 2000.  The follow-up was 8.1 ± 3.1 years.  Pedicled muscle flaps were utilized for small defects while free flaps were the reconstructive choice for defects with exposed tendon, joint, or bone. Outcomes analyzed included postoperative complications, healing rates, time to heal, length of time the wound remained healed, limb salvage, and patient survival. Patient satisfaction and ambulatory status were also evaluated by phone survey.

Thirty-four pedicled muscle flaps were utilized to cover soft tissue defects in 32 patients.  Fifty-two free flaps were utilized to cover defects in 48 patients.  Pedicled muscle flaps resulted in 31/34 wounds healed (91%), a 94% limb salvage rate, and a 74% patient survival rate. There was an overall complication rate of 33% in the pedicled muscle flap group.  Free flaps resulted in 48/51 wounds healed (94%), a 96% limb salvage rate, and a 77% patient survival rate.  There was an overall complication rate of 17% in the free flap group.  There was no statistically significant difference noted in the healing time, complications, flap success, limb salvage, or ambulatory status when comparing patients the diabetic cohort versus the non-diabetic cohort.

Diabetes does not appear to adversely affect complex foot and ankle reconstruction with pedicled muscle flaps or free tissue transfer.  Pedicled muscle flaps were found to be as effective as free flaps for reconstruction.  It should be noted that the presence of diabetes did result in more debridements, longer healing time, and a decreased long-term survival.  However, the limb salvage rate does appear to prolong survival of diabetic patients when compared with historical diabetic controls.  Diabetes does not appear to be a contraindication of flap reconstruction for limb salvage of the foot and ankle.


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