Comparison of the efficacies of free anterolateral thigh perforator flap and descending branch tissue flap of lateral circumflex femoral artery transplantation in the treatment of diabetic foot
Objective To explore the therapeutic effects of free anterolateral thigh perforator flap and free descending branch tissue flap of lateral circumflex femoral artery transplantation combined with vacuum sealing drainage in the treatment of diabetic foot.Methods A total of 94 diabetic foot patients treated at the Second Affiliated Hospital of Air Force Medical University from January 2018 to March 2023 were prospectively selected as the research subjects.They were divided into two groups,group A and B,using the random number table method.In group A,47 patients received free anterolateral thigh perforator flap transplantation,including 24 males and 23 females,aged(53.26±11.52)years,the wounds ranged from 4.2 cm × 5.4 cm to 8.3 cm × 10.2 cm,and the lesions were distributed at dorsum of foot in 15 cases,ankle in 18 cases,and heel in 14 cases.In group B,47 patients received free descending branch tissue flap of lateral circumflex femoral artery transplantation,including 26 males and 21 females,aged(51.34±10.89)years,the wounds ranged from 3.5 cm × 4.5 cm to 7.5 cm × 9.5 cm,and the lesions were distributed at dorsum of foot in 17 cases,ankle in 16 cases,and heel in 14 cases.Both groups underwent debridement with vacuum sealing drainage before surgery.The efficacy,wound healing,growth cytokines in the wound area[vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF),and transforming growth factor-β1(TGF-β1)],flap sensory function,and walking ability(evaluated by Holden's Functional Ambulation Classification Scale)were compared between the two groups.t test x2 test,and rank sum test were used.Results Six months after treatment,the total effective rate of group A was higher than that of group B[97.87％(46/47)vs.87.23％(41/47)],with a statistically significant difference(x2=3.859,P=0.049).The wound healing time[(28.98±4.49)d],hospital stay[(18.98± 5.36)d],and granulation tissue formation time[(21.58±4.22)d]in group A were shorter than those in group B[(31.38±4.76)d,(22.38±6.42)d,and(23.65±4.59)d],with statistically significant differences(all P＜0.05).The levels of VEGF[(113.13±12.82)ng/L],bFGF[(70.08±6.87)ng/L],and TGF-β1[(9.08±0.91)µg/L]in group A 1 month after surgery were higher than those in group B[(102.35±13.11)ng/L,(65.33±6.37)ng/L,and(8.09±0.83)μg/L],with statistically significant differences(all P＜0.05).There was no statistically significant difference in the good appearance rate of flaps between the two groups(x2=0.712,P=0.399).The normal rate of flap sensory function in group A was higher than that in group B[61.7％(29/47)vs.40.42％(19/47)],with a statistically significant difference(.x2=4.257,P=0.039).The Holden's Functional Ambulation Classification in group A was better than that in group B,with a statistically significant difference(Z=10.513,P=0.033).Conclusion The use of free anterolateral thigh perforator flap for the treatment of diabetic foot is superior to free descending branch tissue flap of lateral circumflex femoral artery,with faster wound healing and better recovery of foot and ankle function.
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