Diabetic foot reconstruction using free flaps increases 5-year-survival rate
Diabetic foot reconstruction using free flaps increases 5-year-survival rate
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DOI：
10.1016/j.bjps.2012.09.024
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发表时间：
2013-02-01
影响因子：
2.7
通讯作者：
Hong, Joon Pio
中科院分区：
文献类型：
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作者：
Oh, Tae Suk;Lee, Ho Seung;Hong, Joon Pio
为评价游离皮瓣修复糖尿病足的效果，分析其术前危险因素，对113例糖尿病足患者121例进行了9年以上的随访，平均随访53.2个月。年龄26 ~ 78岁，平均54.6岁。游离皮瓣包括股前外侧皮瓣（ALT，90例）、旋髂浅动脉穿支皮瓣（SCIP，20例）、股前内侧皮瓣（AMT，5例）、股上内侧皮瓣（UMT，3例）和其他穿支皮瓣（3例）。采用Logistic回归模型分析手术效果与术前危险因素的相关性，10例皮瓣完全丧失，111例游离组织移植成功，皮瓣成活率为91.7%。随访期间，17例患者最终失肢，总保肢率为84.9%，5年生存率为86.8%。皮瓣丢失与14项术前危险因素的相关性（计算机断层扫描（CT）血管造影片显示主要血管的完整数量、既往血管成形术史、外周动脉疾病（PAD）、心脏问题、慢性肾衰竭（CRF）、美国麻醉医师协会（阿萨）身体状态分类系统、吸烟、体重指数（BMI）、HBA 1c、淋巴细胞计数、踝臂指数（ABI），分析两组患者骨髓炎、C反应蛋白（CRP）水平及是否服用免疫抑制剂情况。在接受下肢血管成形术的患者中观察到显著的比值比（比值比：17.590，p < 0.001），有PAD（比值比：10.212，p = 0.032）与肾移植术后服用免疫抑制剂的关系（比值比：4.857，p < 0.041）。使用游离皮瓣进行糖尿病足重建有很高的成功率，并显著提高了5年生存率。危险因素如PAD、肢体血管成形术史和移植后使用免疫抑制剂可能会增加皮瓣丢失的机会。(C)2012年英国整形、重建和美容外科医生协会。由爱思唯尔有限公司出版。保留所有权利。
The purpose of this study was to evaluate the outcome of the diabetic foot reconstructed with free flaps and analyse the preoperative risk factors.This study reviews 121 cases of reconstructed diabetic foot in 113 patients over 9 years (average follow-up of 53.2 months). Patients' age ranged from 26 to 78 years (average, 54.6 years). Free flaps used were anterolateral thigh (ALT, 90), superficial circumflex iliac artery perforator (SCIP, 20), anteromedial thigh (AMT, 5), upper medial thigh (UMT, 3), and other perforator free flaps (3). Correlation between the surgical outcome and preoperative risk factors were analysed using logistic regression model.Total loss was seen in 10 cases and 111 free-tissue transfers were successful (flap survival rate of 91.7%). During follow-up, limb was eventually lost in 17 patients and overall limb salvage rate was 84.9% and the 5-year survival was 86.8%. Correlation between flap loss and 14 preoperative risk factors (computed tomography (CT) angiogram showing intact numbers of major vessels, history of previous angioplasty, peripheral arterial disease (PAD), heart problem, chronic renal failure (CRF), American Society of Anaesthesiologists (ASA) physical status classification system, smoking, body mass index (BMI), HBA1c, lymphocyte count, ankle-brachial index (ABI), osteomyelitis, C-reactive protein (CRP) level and whether taking immunosuppressive agents) were analysed. Significant odds ratio were seen in patients who underwent lower extremity angioplasties (odds ratio: 17.590, p < 0.001), with PAD (odds ratio: 10.212, p = 0.032) and taking immunosuppressive agents after kidney transplantation (odds ratio: 4.857, p < 0.041).Diabetic foot reconstruction using free flaps has a high chance for success and significantly increases the 5-year survival rate. Risk factors such as PAD, history of angioplasties in the extremity and using immunosuppressive agents after transplant may increase the chance for flap loss. (C) 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.