(DLS-013) Lessons Learned from the first 15 cases of microsurgical diabetic Foot reconstruction at the Tel-Aviv Medical Center

Introduction:
Recent evidence documenting high success rates following microvascular diabetic foot reconstruction has led to a paradigm shift in favor of more aggressive limb preservation, with data suggesting for better survival outcomes to patients who underwent limb salvage. Since 2020, The department of Plastic and reconstructive Surgery at the Tel Aviv medical center offers free tissue transfer (FTT) for recalcitrant diabetic foot ulcers (DFUs) for advanced limb salvage. The primary aim of this study was to examine reconstructive and functional outcomes of these patients and the secondary was to asses the major difficulties we have encountered while starting up this service

Methods: Between March 2020 and July 2022, 15 patients underwent lower extremity FTT for diabetic foot reconstruction by the senior author (D.J.K). In all cases, microsurgical reconstruction was offered as an alternative to major amputation for the management of recalcitrant DFUs. Overall rates of flap survival, limb salvage, and postoperative ambulation were evaluated

Results:
Overall rates of flap success at one month and lower limb salvage at one Year were 87% and 90%, respectively. Flap failure occurred in two patients with delayed microvascular compromise. 2 patients in this series ultimately required below-knee amputation secondary to recalcitrant infection, and one needed a second free flap at 15 month due to recurrent limb ischemia. Patients underwent on average 3.26 debridements prior to reconstruction including deep tissue and bone biopsies and still 33% of the patients needed Antibiotic adjustment due to acquiring new resistance or new organisms that were cultured from the time of reconstruction. Postoperative ambulation was confirmed in 12 after a mean of 46 days (r, 28-90 days)

Discussion: FTT for the management of recalcitrant DFUs is associated with high rates of reconstructive success and postoperative ambulation.
Emphasis should be put on repeated deep cultures and antibiotic adjustments.

These data should be used to counsel patients regarding the risks, functional implications, and prognosis of microvascular diabetic foot reconstruction.