[Plastic surgery options for the treatment of chronic foot ulcers]

A large number of possibilities to cover chronic ulcers are available. The special aspects of the diabetic foot need to be considered when selecting a flap design for coverage.

The purpose of this work is to discuss which plastic surgery techniques are preferred when treating chronic ulcers of the diabetic foot.

Analysis of our own cases and discussion of basic literature.

Muscle flaps generally have better perfusion and increased angiogenic activity than skin flaps and, therefore, have better results in the treatment of chronic wounds. Especially important when choosing a procedure for the treatment of the diabetic foot is the situation of vessels and perfusion.

An interdisciplinary approach with internal, orthopedic, and radiological specialists from the beginning of the treatment is the basis for success. The pedicled myocutaneous instep flap with inclusion of the abductor hallucis muscle allows stable coverage in the weight bearing area to be obtained. Free flaps like the anterolateral thigh flap should be raised including a muscle (part of vastus lateralis muscle) to achieve multilayer coverage. Postoperative wound care and training of the flap by the patient are also important for successful treatment and need to be guaranteed in advance.