Clinical effects of free anterolateral thigh perforator flaps in repairing diabetic foot ulcers under a multi-disciplinary team cooperation model
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.
NETL
NSTL
万方数据
