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Soft-tissue reconstruction for recalcitrant diabetic foot wounds
B K Cohen1, D D Zabel, E D Newton
1The Western Pennysylvania Hospital, Pittsburgh, USA.
Summary
The medial plantar artery flap effectively reconstructs plantar soft-tissue defects in diabetic patients, offering a viable solution for complex foot wounds.
Area of Science:
- Orthopedic Surgery
- Plastic Surgery
- Diabetic Foot Care
Background:
- Diabetic foot defects often arise from abnormal weight-bearing and neuropathy.
- Reconstruction of plantar soft-tissue defects presents unique challenges due to functional demands.
Purpose of the Study:
- To evaluate the efficacy of medial plantar artery (MPA)-based flaps for reconstructing plantar soft-tissue defects.
- To assess complication rates and functional outcomes in diabetic patients undergoing MPA flap reconstruction.
Main Methods:
- Retrospective review of 33 diabetic patients (1984-1997) with plantar soft-tissue defects.
- Reconstruction utilized MPA-based flaps for heel, midfoot, and forefoot defects.
- Data collected on patient demographics, defect size, follow-up duration, and complications.
Main Results:
- MPA flap reconstruction was performed on 33 patients with an average tissue deficit of 13 cm².
- Mean follow-up was 19 months; 4 minor complications (necrosis, infection) and 6 major complications (flap loss, amputation) occurred.
- Seven patients required 12 flap rerotations.
Conclusions:
- Medial plantar artery flap reconstruction is an effective surgical option for diabetic foot defects.
- While complications can occur, MPA flaps offer a means to restore soft tissue coverage.
- The use of glabrous skin provides beneficial pressure and shear resistance for plantar reconstructions.