J Wound Manag Res.  2021 Feb;17(1):19-23. 10.22467/jwmr.2020.01207.

Reconstruction of Plantar Forefoot in Diabetic Foot Ulcers: A Comparative Study of Perforator Flaps and Random Flaps

• Kim YS
• Roh SG
• Kim JL
• Lee NH
• Shin JY

• KMID: 2513919
• DOI: http://doi.org/10.22467/jwmr.2020.01207

Abstract

Background
Plastic and reconstructive surgeons consider a variety of options to salvage limbs of patients when operating on soft tissue defects of the plantar forefoot in diabetic foot ulcers. This study focuses on the efficacy and durability of perforator flaps compared to that of random flaps, when covering the plantar forefoot area in diabetic patients.

Methods
From January 2011 to August 2020, we performed 49 plantar forefoot reconstructions to cover soft tissue defects in diabetes patients using local random flaps, regional perforator-based flaps, or free flaps. The patients’ clinical characteristics, size of defects, surgical outcomes and complications were reviewed retrospectively.

Results
Forty-nine patients underwent plantar forefoot reconstruction over the period reviewed. Eleven patients were female and the others were male. The mean age of the patients was 54.2 years (range, 32–73 years). Median follow-up was 5.2 months. The mean size of the defect was 7.2×4.5 cm. During follow-up periods, partial or complete loss of flaps was closely observed. We identified wound complications in 67% of local random flaps compared to 11% and 21% in regional and free flaps, respectively.

Conclusion
Soft tissue defects in the distal third of the foot can severely worsen diabetic patients’ quality of life. Perforator-based flaps, providing better vascularized tissue than random flaps, can be used to attain acceptable functional and aesthetic results for plantar forefoot reconstruction in diabetes patients.

Keyword

Diabetic foot ulcer; Reconstructive surgery; Perforator flap