Diabetic Foot Preservation in End-Stage Renal Disease with Combined Angioplasty and Free Flap Reconstruction

Diabetic foot disease is a significant global health problem, contributing to poor wound healing and an increased risk of lower extremity amputation. These challenges are exacerbated in patients with diabetes and end-stage renal disease (ESRD). There is limited evidence on the long-term efficacy of combined angioplasty and free flap reconstruction for limb preservation in the diabetic ESRD population. The authors report the long-term outcomes of this limb preservation approach.

A retrospective cohort study was conducted in patients with diabetes receiving hemodialysis who had peripheral arterial occlusive disease and soft-tissue defects of the foot. Patients who underwent endovascular revascularization followed by free flap reconstruction for lower limb preservation at Dalin Tzu Chi General Hospital, Taiwan, from January of 2010 through January of 2022 were included. The primary objective was to report outcomes in this cohort. The secondary objective was to identify risk factors for flap loss, lower limb amputation, and death.

The authors analyzed 40 legs of 35 patients who underwent the combined procedure. The median follow-up was 559.5 days. The flap success rate was 92.5%. The 1-, 2-, and 5-year limb preservation rates were 97%, 91.9%, and 83.5%, respectively. Patient survival rates at 1, 2, and 5 years were 65%, 46%, and 21.6%. Age ( P = 0.043), smoking history ( P = 0.026), and cerebrovascular accident history ( P = 0.0003) were associated with higher risks of major limb amputation.

Free flap reconstruction for diabetic foot disease in patients with ESRD is reliable and has a high limb preservation rate. However, this may not translate to improved patient survival over a 5-year period.