Ramanujam CL, Stuto AC, Zgonis T, et al.
Journal of wound care. Date of publication 2018 Sep 1;volume 27(Sup9):S22-S28.
1. J Wound Care. 2018 Sep 1;27(Sup9):S22-S28. doi: 10.12968/jowc.2018.27.Sup9.S22.
Use of local intrinsic muscle flaps for diabetic foot and ankle reconstruction: a
systematic review.
Ramanujam CL(1), Stuto AC(2), Zgonis T(3).
Author information:
(1)Assistant Professor/Clinical and Division Chief, Division of Podiatric
Medicine and Surgery, Department of Orthopaedics, University of Texas Health San
Antonio Long School of Medicine, San Antonio, Texas, US.
(2)Specialist and Fellow in Reconstructive Foot and Ankle Surgery, Division of
Podiatric Medicine and Surgery, Department of Orthopaedics, University of Texas
Health San Antonio Long School of Medicine, San Antonio, Texas, US.
(3)Professor and Director, Externship and Reconstructive Foot and Ankle Surgery
Fellowship Programs, Division of Podiatric Medicine and Surgery, Department of
Orthopaedics, University of Texas Health San Antonio Long School of Medicine, San
Antonio, Texas, US.
OBJECTIVE: To assess the outcomes of local intrinsic muscle flaps specifically in
the surgical reconstruction of foot and ankle wounds in patients with diabetes.
METHOD: A systematic review of the literature was conducted by three independent
reviewers using several databases and search engines. The following search terms
were used: foot, ankle, diabetes mellitus, peripheral neuropathy, Charcot
neuroarthropathy, ulceration, wound, muscle, flap, surgical offloading, diabetic
reconstruction, local intrinsic, abductor digiti minimi, abductor hallucis,
extensor digitorum brevis, flexor digitorum brevis, flexor digiti minimi. Studies
meeting the following criteria were included: English language studies, studies
published from 1997 to 2017 (inclusive of the last 20 years), patients with
diabetes treated for foot and/or ankle wounds, use of local intrinsic muscle
flaps, follow-up period of six months or more postoperatively, documentation of
healing rates, complications, and need for revisional surgery. Studies that were
entirely literature reviews, descriptions of only surgical technique and/or
cadaveric studies and patients without diabetes were excluded.
RESULTS: A total of 13 selected studies met the above inclusion criteria and were
used for data extraction from a total of 113 patients in which 92 local intrinsic
muscle flaps were performed for diabetic foot and/or ankle reconstruction, of
which 80 (87%) muscle flaps demonstrated success, while 12 (13%) flaps
encountered complications.
CONCLUSION: Although local intrinsic muscle flaps demonstrated a relatively high
success rate when used for the definitive closure of certain diabetic foot and
ankle wounds based on existing evidence, our systematic review emphasises the
need for more high-quality, larger comparative studies to investigate their
efficacy and failure rates in diabetic foot and/or ankle reconstruction.
DOI: 10.12968/jowc.2018.27.Sup9.S22
PMID: 30207840
