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Reconstruction Using Free Flaps for Diabetic Heel Defects: Outcomes and Risk Factor Analysis
Hyung Bae Kim1, Mehmet Altiparmak1, Changsik John Pak1
1Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Journal of Reconstructive Microsurgery
|April 7, 2020
Summary
Diabetic heel reconstruction with free flaps has a 73% survival rate, but impaired heel arterial status significantly increases failure risk. Success leads to limb salvage, while failure often results in higher amputation levels.
Area of Science:
- Microsurgery
- Reconstructive Surgery
- Diabetic Foot Care
Background:
- Diabetic foot reconstruction using free flaps has acceptable success rates, but heel reconstruction remains challenging.
- The heel region presents unique difficulties for free flap reconstruction in diabetic patients.
Purpose of the Study:
- To evaluate free flap outcomes for diabetic foot heel reconstruction.
- To identify risk factors associated with free flap failure in diabetic heel reconstruction.
Main Methods:
- Retrospective review of 37 patients undergoing free flap reconstruction for diabetic heel ulcers (2008-2017).
- Analysis of flap outcomes and risk factors including arterial status, American Society of Anesthesiologists (ASA) physical status, and comorbidities.
- Statistical analysis to determine factors significantly impacting flap survival.
Main Results:
- Overall flap survival rate was 73%, achieving limb salvage and functional ambulation.
- Flap loss occurred in 27% of cases, predominantly leading to high-level amputations.
- Impaired arterial status of the heel (odds ratio 80) and ASA status were significant predictors of flap failure (p<0.05).
Conclusions:
- Vascularity of the surrounding tissue is critical for successful diabetic heel reconstruction.
- Aggressive debridement guided by the angiosome concept is essential for ensuring adequate tissue circulation.
- Despite high failure risks, successful reconstruction offers limb salvage; failure necessitates higher amputation levels, emphasizing the need for maximizing vascularity through techniques like angioplasty.
