{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T02:58:02Z","timestamp":1790391482205,"version":"4.1.0"},"reference-count":23,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2009,10,13]],"date-time":"2009-10-13T00:00:00Z","timestamp":1255392000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2010,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Major amputation for advanced soft tissue loss with bone and tendon exposure, can be prevented in diabetes patients with a combined arterial reconstruction and free\u2010flap transfer. We reviewed our 15\u2010year outcome and evaluated the feasibility to save diabetic feet by means of this aggressive strategy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 55 type II diabetes patients (42\u201380 years of age), hospitalized between January 1992 and December 2006 for a combined arterial reconstruction and free\u2010flap transfer, were followed until December 2007. All would have otherwise required at least a below\u2010knee amputation. Arterial reconstructions, preferentially with autologous vein, were performed in combination with free tissue transfer, simultaneously or staged. The rectus abdominis muscle was the most frequently used muscle graft, although in recent years a growing number of alternative muscle and perforator flaps were used.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean follow\u2010up was 22\u00a0months (range: 1\u2013180\u00a0months). Major complications occurred in 37% with only one in\u2010hospital death. Major amputations were performed in 15 patients, 5\u00a0in the early postoperative period. The 1\u2010year and 3\u2010year limb salvage rates were 75.8 and 64.3%, with a 1\u2010year and 3\u2010year amputation\u2010free survival of 69.5% and 55.8%. The 1\u2010year and 3\u2010year secondary patency for graft and free flap was 78.7% and 60.2%, respectively. Renal insufficiency was a major risk factor for limb loss (Hazard Ratio [HR] 5.581 (95% Confidence Interval [CI] 1.384\u201322.5)). Independent ambulation was regained in 38 patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Combined arterial reconstruction and free tissue transfer provides an excellent long\u2010term result with regard to amputation\u2010free survival and limb salvage. It should be considered in every diabetes patient with extensive soft tissue deficits before amputation is performed.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-009-0250-9","type":"journal-article","created":{"date-parts":[[2009,10,12]],"date-time":"2009-10-12T17:17:05Z","timestamp":1255367825000},"page":"177-184","source":"Crossref","is-referenced-by-count":33,"title":["Outcome of Arterial Reconstruction and Free\u2010Flap Coverage in Diabetic Foot Ulcers: Long\u2010Term Results"],"prefix":"10.1002","volume":"34","author":[{"given":"Caren","family":"Randon","sequence":"first","affiliation":[{"name":"Department of Thoracic and Vascular Surgery Ghent University Hospital Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Vermassen","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Vascular Surgery Ghent University Hospital Ghent 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