Different Surgical Modalities for Reconstruction of Soft Tissue Defects in Diabetic Foot Ulcers; A Metaanalysis

Abstract

oot ulceration is a very common complication in diabetic patients. It is well established that about 25% of people with diabetes develop a foot ulcer during their lifetime and 20% of all diabetic patients who enter the hospital are admitted for foot problems. Neuropathy plays a major role in the development of diabetic foot ulcers through its sensory, motor and autonomic components. Also, ischemic changes and hemorheologic abnormalities with functional alteration of capillary blood flow as well as increased liability of diabetic patients to infection are important pathogenetic factors in the occurrence and aggravation of foot ulcers. The University of Texas classification and PEDIS classification systems are the most appropriate and commonly used for classifying diabetic foot wounds. Treating diabetic foot ulcers and gangrene can better be done effectively by using a team approach which at the minimum includes a wound care team, a vascular surgeon, a plastic surgeon, an infectious disease specialist, an endocrinologist, and a prosthetist. The wound needs to be accurately assessed, debrided, and cultured. The vascular and medical status has to be optimized. The repair is then dictated by how much of the foot remains after debridement and how the foot can be closed in the most biomechanically stable construct possible. This may involve skeletal manipulation, tendon lengthening, and or partial foot amputations. Soft tissue