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CZECH MEDICAL ASSOCIATION J. Ev. PURKYNĚ |
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Česky / Czech version | ACTA CHIRURGIAE PLASTICAE, 43, 2001, No. 1, p. 11-15 |
Microsurgery in the diabetic foot Dražan, Veselý, Leypold, Julínek, Lžičařová Clinic of Platic and Aesthetic Surgery Second Surgical Clinic First Medical Clinic Institute of Pathological Anatomy St. Ann University Hospital, Brno, Czech Republic |
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Summary: The treatment of serious tissue defects on the diabetic foot is complicated and tedious because of a combination
of pathogenetic mechanisms that influence healing. Diabetic neuropathies (sensory, motor, vegetative), ischaemia
and microangiopathies contribute in varying degrees to the adverse healing.
The submitted three-year prospective study was focused on an analysis of the pathogenetic factors with the objective of defining the indications for one of three types of microsurgical transfer: 1. a free flap sutured directly to
the vessels at the site of the defect (in predominantly neuropathic defects); 2. a free flap sutured to a popliteopedal bypass (in predominantly ischaemic defects); 3. a „nourishing” flap sutured by means of a long venous
graft to vessels of the medial and upper leg (in patients in whom an inadequate outflow tract does not make revascularisation possible).
In the first year of the investigation, thirteen patients were operated on by means of a free muscle flap incl. three
„nourishing” and ten sutured at the site of the defect. Twelve flaps were flaped healed; one patient died from
myocardial infarction on the second day after surgery.
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