What is the Impact of Infrapopliteal Endovascular Intervention on Free Flap Survival in Diabetic Foot Reconstruction?

Abstract Background The combination of endovascular intervention and microvascular free flap transfer has been effectively used for the chronic ischemic wounds of lower limb. This study aimed to indicate the influence of angioplasty on the free flap survival in diabetic foot ulcer reconstruction.Methods A retrospective research was conducted of 46 diabetic patients with chronic ulcer of the foot. All the patients underwent the free flap reconstruction because of their non-healing wound with tendon or bone exposure. Patient’s demography, clinical data related to vascular status, vascular intervention, free flap transfer procedure were collected. Flap survival rate was compared between the group of severe arterial stenosis and non-severe group and between the different revascularization result groups as well. Results The average was 56.2 ± 10.8 years with 14 men (30.4%) and 32 women (69.6%). All of 23 patients (50%) who had severe infrapopliteal arterial stenosis underwent endovascular intervention. The final result of the pedal arch was type 1 in 13/23 patients (56.5%), type 2A and 2B in 7/23 and 2/23 patients respectively and type 3 in only one patient. Total flap necrosis was in 5 cases (10.9%), marginal necrosis in 4 cases (8.7%) and wound dehiscence in 4 cases (8.7%). There was no significant difference of flap loss between the severe arterial stenosis patients and non-severe arterial stenosis patients. In severe arterial stenosis group, after endovascular intervention, patients with type 1 of pedal arch had a significantly lower rate of total flap necrosis compared to the others. There was also no association between using of revascularized recipient artery and flap survival.Conclusions Our study revealed the crucial of quality of pedal arch on free flap survival. The PTA should aim to re-establish the complete pedal arch to increase the rate of wound healing as well as the flap success.