Surgical Coverage of Diabetic Feet

Historically, patients with chronic diabetic foot ulcers were managed with major lower extremity amputations such as below-knee amputations and above-knee amputations. With the advancement of microsurgical techniques, patients have been able to achieve limb salvage and reap the associated morbidity and mortality benefits. In order to ensure successful limb salvage, a patient’s biomechanic, diabetic, vascular, and infectious profiles need to be optimized. Serial debridement supplemented with antibiotics until negative deep tissue cultures is the gold standard for infection eradication. A surgeon needs to have a good understanding of patient and wound-specific anatomic considerations. Simpler techniques, such as primary closure, skin grafting, and Integra placement, may be used.  In complex wounds, more involved reconstructive modalities, such as local flap or free tissue transfer, may be required. Coverage selection depends on an intimate understanding of the patient’s comorbidities, wound characteristics, and vascular status. This review contains 7 figures, 2 tables, and 32 references. Keywords: diabetic foot ulcer, chronic wound, nonhealing vasculopathic wound, local flap, free flap, free tissue transfer, abductor digiti minimi flap, abductor hallicus flap, flexor digitorum brevis flap