J Korean Orthop Assoc.  2008 Feb;43(1):43-49. 10.4055/jkoa.2008.43.1.43.

Operative Treatment for Neuropathic Diabetic Foot Ulcer: Usefulness of V-Y Advancement Flap for Unhealing Plantar Ulcer

• Kim JY
• Rhee JJ

• KMID: 2106415
• DOI: http://doi.org/10.4055/jkoa.2008.43.1.43

Abstract

PURPOSE: This study examined the results of a single or double V-Y advancement flap, which was found to be technically simple for the management of chronic plantar ulcer in patients with neuropathic diabetic foot.
MATERIALS AND METHODS
From January 2004 to December 2005, 29 patients who were hospitalized for the management of a neuropathic diabetic foot plantar ulcer were examined. All patients underwent single- or double-V-Y advancement flap for the management of the ulceration. Hematological, hemodynamic, diabetic, bacteriologic, and radiological tests wereperformed prior to surgery. The condition of the wound was checked during surgery, and the healing rate, healing time and recurrence during the follow-up examinations were evaluated after surgery.
RESULTS
The mean age of the patients was 53.4 years (36-69). The plantar ulcers were the most commonly found in the forefoot area (12 cases). Nine cases showed ulcers in the hindfoot area, 6 cases were found are in the lateral foot area, and 2 cases were identified in the medial foot area. The area covered with the V-Y advancement flap averaged 2.05 cm(2) (0.8-3.9). The mean healing time of the wound was 4.7 weeks (3-8). One day after surgery, there were 7 cases of partial circulation disturbance that were managed with a partial stitch out and secondary intension wound healing. There were 5 cases of recurrence of the wound.
CONCLUSION
A V-Y advancement flap to manage chronic diabetic plantar ulcers can produce excellent or good results. However, a high incidence of delay in healing of the surgical wound can be expected, and a longer period is needed to protect the wound comparing with normal patients.

Keyword

Chronic foot plantar ulcer; V-Y advancement flap; Diabetes; Neuropathy

MeSH Terms

Diabetic Foot
Follow-Up Studies
Foot
Foot Ulcer
Hemodynamics
Humans
Incidence
Recurrence
Ulcer
Wound Healing

Figure

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  Fig. 1 Standard V-Y advancement flap. The V-shaped incision was designed so that the resulting stem of the "Y" will lie perpendicular to the RSTL.

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  Fig. 2 Souble V-Y advancement flap. (A) Two V-shape flaps were incised on the opposing sites of the defect. (B) The flaps were advanced toward each other. (C) Final appearance.

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  Fig. 3 These serial clinical photographs show how to perform the V-Y advancement flap. (A) A ulcer occurred on the heel of the foot shows the classical shape of a chroniculcer; round or oval shape and loss sharp angle, covered with abnormal skin that is thick with a loss of elasticity. (B) The area was measured after removing the abnormal skin, in this state. A double V-Y advancement flap was designed because the area was above 3 cm2. (C) After the skin incision, care must be taken not to cut the perforating branch coming out through the muscular fascia and cut the collagen fiber that is inhibiting flap movement. (D) This photograph show the closed wound after suturing.

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  Fig. 4 These serial clinical photographs show a example of the successful healing of a chronic diabetic foot ulcer that occurred 37 months earlierusing a double V-Y advancement flap.

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