Here - EWMA 2013

E-POSTER: DIABETIC FOOT
E-Poster: Diabetic Foot
EP 462
How about the Free Flap as the First Choice of Treatment for
Diabetic foot: Tips for Success.
Donghyuk Shin 1
1 Konkuk University Medical Center (Seoul, Korea).
Aim: Because most of diabetic ulcers occur in weight bearing area or prehensile region,
the flap surgery is indispensable for satisfactory result in this case, but making adequate
regional flap from foot is difficult. When free flap is the only choice, how much can we
guarantee the result? With confidence in free flap as first choice of treatment through my
experiences, I would like to share some tips successful outcomes.
Methods: From September 2010 to May 2012, 45 patients underwent free flap for their
diabetic foot reconstruction. Preoperatively, diabetic period, HbA1c, nephropathy,
cardiac dysfunction, and angiogram were investigated. Selection of recipient vessel was
made by preoperative angiography and Doppler tracing. If indicated, dobutamine was
used to increase cardiac output and blood pressure.
Results: Overall, there were 7 total and 9 partial losses. 39 patients had preoperative
interventional angioplasty and 7 total losses occurred in this group. In six patients, major
vessels were used as recipient. Among six cases, 3 flaps were totally failed, and one
showed partial loss. In case of 4 end-stage renal disease(ESRD), every flap survived
completely. In five cases that had dobutamine infusion, there were one total and one
partial loss.
Conclusions: Currently, the success rate of free flap is mentioned as more than 95%,
however, similar rate could not be expected in diabetic foot ulcer. Though, the success
rate is too low to look away. Through my experience, I think the free flap can be the first
choice of treatment and desire to propose some tips for success.
EP 463
The Use of Topical Oxygen in a Complicated Post Surgical
Transmetatarsal Amputation with Incision and Drainage of
the Foot
E-Poster: Diabetic Foot
Francis Derk 1 , Mike Griffiths 2
1 South Texas VA Medical Center (San Antonio, United States);
2 AOTI (Oceanside, United States).
Aim: 47 y/o Female with severe DM, Retinopathy, and Neuropathy presented to the ER
with a severe left foot infection. A multidisciplinary team approach was attained and
collaboration was established with Podiatry, Vascular Surgery, and Infectious Disease.
The patient had palpable pulses (2/4) audible upon bedside testing. The patient
presented with a 560 glucose level along with normocytic anemia with an H/H of
7.9/25.3. Transmetatarsal Amputation with Incision and Drainage of the Foot was
performed. 2 units of packed RBCs were given during surgery and 2 more units were
given at post op day 1.
Methods: Negative pressure device was used for 3 days and then discontinued due to
pain and discomfort. Topical O2 therapy was initiated following surgery bid for 90 mins.
The patient was discharged on post op day 6 and was placed on po Augmentin 500/125
mgs bid for 14 days. Wound dressings consisted of light wet to dry packing changed bid
in conjunction with Topical O2 therapy bid/90 mins. Patient also placed in removable
posterior splint for 3 weeks and then transitioned to a CAM boot until healed.
Results: Wound healed completely in 8 weeks.
Conclusions: Very complicated case of Diabetic Foot infection that responded favorably
to Topical Oxygen Therapy, that was very effective not only from a wound healing
perspective, but also in providing the patient with comfort, direct involvement with her
wound care, and ease of use at home
EWMA 2013
COPENHAGEN
15-17 May · 2013
Danish Wound
Healing Society
267