Protective association of free flap reconstruction with vascular restenosis after angioplasty in patients with diabetic foot.

Abstract

Peripheral arterial occlusive disease (PAOD) in patients with diabetic foot is one of the most refractory conditions in wound management. To address this complication, revascularization via angioplasty offers several advantages, including its minimally invasive nature and high technical success rates. However, restenosis remains a critical limitation, which suggests the need for alternative strategies such as free tissue transfer. In this study, we investigated whether free flap reconstruction confers a protective effect against vascular restenosis. A retrospective cohort study was conducted on patients with diabetic foot ulcers who underwent primary angioplasty between January 2015 and March 2023. Patients were divided into two groups: the free flap (n=30) and conservative (n=30) groups. Data were collected for analysis including demographic data (sex, age, smoking status, presence of osteomyelitis, end-stage renal disease on hemodialysis (ESRD on HD), and HbA1C level) and vascular severity using TASC classification. Re-angioplasty was significantly less frequent in the free flap group compared to the conservative group (10.0% vs. 63.3%, p<0.001). In terms of clinical outcomes, the limb salvage rate was significantly higher in the free flap group (66.7% vs. 20.0%, p<0.001). No demographic variables were significantly associated with re-angioplasty except ESRD on HD (68.2% vs. 36.8%, p=0.019). On multivariate analysis, free flap reconstruction remained the only significant independent factor associated with reduced re-angioplasty risk (aOR=0.073, p=0.003). This retrospective study demonstrated that free flap reconstruction was significantly associated with reduced risk of re-angioplasty in patients with diabetic foot. These findings suggest that the combined application of endovascular revascularization and free flap reconstruction represents an effective strategy for improving limb salvage outcomes.