A systematic review of free tissue transfer in the management of non-traumatic lower extremity wounds in patients with diabetes.

Abstract

Wounds of the lower limb in patients with diabetes are frequently difficult to heal. Some wounds fail to heal despite optimal medical and surgical care. This review examines the evidence for whether free tissue transfer techniques may reduce the requirement of amputation in these patients. A systematic review. Pubmed, Embase, AMED, SCOPUS and CINAHL and Cochrane Library were searched for all articles on free tissue transfer in lower limb wounds in patients with diabetes (September 2010). Current experience, indications and outcomes were analysed. 528 patients from 18 studies were included in the systematic review. 66% of patients had concomitant revascularisation with bypass surgery. 63% of flaps were muscle based, 35% fasciocutaneous and 1.7% omental. Pooled in-hospital mortality rate was 4.4%, flap survival was 92% and limb salvage rate of 83.4% over a 28 months average follow-up time. In conclusion free tissue transfer achieves successful wound healing in selected patients with diabetes and difficult to heal wounds that would have required amputation. Pre-operative optimisation of vascular supply and eradication of infection is key to success. Objective wound assessment scores and a clear multidisciplinary team (MDT) approach would improve patient care.