{"title":"游离大腿前外侧皮瓣修复糖尿病足溃疡术中血流灌注因子分析。","authors":"Hong-Liang Wu, Huan Huang, Bin-Qi Chen, Jian Xia, Li-Bing Jiang","doi":"10.4239/wjd.v16.i8.105532","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Diabetic foot ulcers (DFUs) in patients with type 2 diabetes (T2D) are associated with heightened risks of infection and amputation and thus require effective surgical interventions to enhance outcomes. Free anterolateral thigh (ALT) perforator flap is a promising reconstructive method; however, diabetic vasculopathy challenges optimal perfusion. This study analyzes factors influencing intraoperative blood perfusion in ALT flap repair for DFUs.</p><p><strong>Aim: </strong>To identify key factors affecting intraoperative blood perfusion during free ALT perforator flap repair in patients with T2D and DFUs, thereby providing insights to improve surgical outcomes.</p><p><strong>Methods: </strong>This retrospective case-control study included 100 patients with T2D who underwent ALT flap repair at our institution between June 2016 and June 2024. Patients were categorized into normal (<i>n</i> = 50) and abnormal (<i>n</i> = 50) blood perfusion groups based on intraoperative perfusion assessments. Data on demographics, clinical characteristics, vascular status, metabolic control, and preoperative laboratory parameters were collected. Statistical analyses, including univariate and multivariate logistic regression, were conducted to identify significant predictive factors for perfusion outcomes.</p><p><strong>Results: </strong>Old age, high body mass index, long diabetes duration, and presence of diabetic peripheral neuropathy were associated with impaired perfusion. Abnormal perfusion was correlated with poor ankle-brachial index and elevated glycated hemoglobin (HbA1c), creatinine, triglycerides, and partial pressure of carbon dioxide. Conversely, high hemoglobin, albumin, and prealbumin levels and partial pressure of oxygen (PaO<sub>2</sub>) were protective. Multivariate analysis identified diabetes duration, HbA1c, PaCO<sub>2</sub>, PaO<sub>2</sub>, and albumin as independent predictors of perfusion, underscoring the roles of metabolic control and vascular health.</p><p><strong>Conclusion: </strong>Optimizing metabolic control, vascular health, and nutritional status was crucial to enhance intraoperative blood perfusion in diabetic patients undergoing ALT perforator flap repair for DFUs.</p>","PeriodicalId":48607,"journal":{"name":"World Journal of Diabetes","volume":"16 8","pages":"105532"},"PeriodicalIF":4.6000,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432585/pdf/","citationCount":"0","resultStr":"{\"title\":\"Intraoperative blood perfusion factors in free anterolateral thigh flap repair for diabetic foot ulcers: A retrospective analysis.\",\"authors\":\"Hong-Liang Wu, Huan Huang, Bin-Qi Chen, Jian Xia, Li-Bing Jiang\",\"doi\":\"10.4239/wjd.v16.i8.105532\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Diabetic foot ulcers (DFUs) in patients with type 2 diabetes (T2D) are associated with heightened risks of infection and amputation and thus require effective surgical interventions to enhance outcomes. Free anterolateral thigh (ALT) perforator flap is a promising reconstructive method; however, diabetic vasculopathy challenges optimal perfusion. This study analyzes factors influencing intraoperative blood perfusion in ALT flap repair for DFUs.</p><p><strong>Aim: </strong>To identify key factors affecting intraoperative blood perfusion during free ALT perforator flap repair in patients with T2D and DFUs, thereby providing insights to improve surgical outcomes.</p><p><strong>Methods: </strong>This retrospective case-control study included 100 patients with T2D who underwent ALT flap repair at our institution between June 2016 and June 2024. Patients were categorized into normal (<i>n</i> = 50) and abnormal (<i>n</i> = 50) blood perfusion groups based on intraoperative perfusion assessments. Data on demographics, clinical characteristics, vascular status, metabolic control, and preoperative laboratory parameters were collected. Statistical analyses, including univariate and multivariate logistic regression, were conducted to identify significant predictive factors for perfusion outcomes.</p><p><strong>Results: </strong>Old age, high body mass index, long diabetes duration, and presence of diabetic peripheral neuropathy were associated with impaired perfusion. Abnormal perfusion was correlated with poor ankle-brachial index and elevated glycated hemoglobin (HbA1c), creatinine, triglycerides, and partial pressure of carbon dioxide. Conversely, high hemoglobin, albumin, and prealbumin levels and partial pressure of oxygen (PaO<sub>2</sub>) were protective. Multivariate analysis identified diabetes duration, HbA1c, PaCO<sub>2</sub>, PaO<sub>2</sub>, and albumin as independent predictors of perfusion, underscoring the roles of metabolic control and vascular health.</p><p><strong>Conclusion: </strong>Optimizing metabolic control, vascular health, and nutritional status was crucial to enhance intraoperative blood perfusion in diabetic patients undergoing ALT perforator flap repair for DFUs.</p>\",\"PeriodicalId\":48607,\"journal\":{\"name\":\"World Journal of Diabetes\",\"volume\":\"16 8\",\"pages\":\"105532\"},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2025-08-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432585/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World Journal of Diabetes\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.4239/wjd.v16.i8.105532\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Diabetes","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4239/wjd.v16.i8.105532","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
Intraoperative blood perfusion factors in free anterolateral thigh flap repair for diabetic foot ulcers: A retrospective analysis.
Background: Diabetic foot ulcers (DFUs) in patients with type 2 diabetes (T2D) are associated with heightened risks of infection and amputation and thus require effective surgical interventions to enhance outcomes. Free anterolateral thigh (ALT) perforator flap is a promising reconstructive method; however, diabetic vasculopathy challenges optimal perfusion. This study analyzes factors influencing intraoperative blood perfusion in ALT flap repair for DFUs.
Aim: To identify key factors affecting intraoperative blood perfusion during free ALT perforator flap repair in patients with T2D and DFUs, thereby providing insights to improve surgical outcomes.
Methods: This retrospective case-control study included 100 patients with T2D who underwent ALT flap repair at our institution between June 2016 and June 2024. Patients were categorized into normal (n = 50) and abnormal (n = 50) blood perfusion groups based on intraoperative perfusion assessments. Data on demographics, clinical characteristics, vascular status, metabolic control, and preoperative laboratory parameters were collected. Statistical analyses, including univariate and multivariate logistic regression, were conducted to identify significant predictive factors for perfusion outcomes.
Results: Old age, high body mass index, long diabetes duration, and presence of diabetic peripheral neuropathy were associated with impaired perfusion. Abnormal perfusion was correlated with poor ankle-brachial index and elevated glycated hemoglobin (HbA1c), creatinine, triglycerides, and partial pressure of carbon dioxide. Conversely, high hemoglobin, albumin, and prealbumin levels and partial pressure of oxygen (PaO2) were protective. Multivariate analysis identified diabetes duration, HbA1c, PaCO2, PaO2, and albumin as independent predictors of perfusion, underscoring the roles of metabolic control and vascular health.
Conclusion: Optimizing metabolic control, vascular health, and nutritional status was crucial to enhance intraoperative blood perfusion in diabetic patients undergoing ALT perforator flap repair for DFUs.
期刊介绍：
The WJD is a high-quality, peer reviewed, open-access journal. The primary task of WJD is to rapidly publish high-quality original articles, reviews, editorials, and case reports in the field of diabetes. In order to promote productive academic communication, the peer review process for the WJD is transparent; to this end, all published manuscripts are accompanied by the anonymized reviewers’ comments as well as the authors’ responses. The primary aims of the WJD are to improve diagnostic, therapeutic and preventive modalities and the skills of clinicians and to guide clinical practice in diabetes. Scope: Diabetes Complications, Experimental Diabetes Mellitus, Type 1 Diabetes Mellitus, Type 2 Diabetes Mellitus, Diabetes, Gestational, Diabetic Angiopathies, Diabetic Cardiomyopathies, Diabetic Coma, Diabetic Ketoacidosis, Diabetic Nephropathies, Diabetic Neuropathies, Donohue Syndrome, Fetal Macrosomia, and Prediabetic State.
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