{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T17:24:22Z","timestamp":1791653062778,"version":"4.3.4"},"reference-count":22,"publisher":"Georg Thieme Verlag KG","issue":"02","license":[{"start":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T00:00:00Z","timestamp":1703030400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Plast Surg"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003The impact of diabetes on complication rates following free flap (FF), pedicled flap (PF), and amputation (AMP) procedures on the lower extremity (LE) is examined.<\/jats:p><jats:p>\n          Methods\u2003Patients who underwent LE PF, FF, and AMP procedures were identified from the 2010 to 2020 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP\u00ae) database using Current Procedural Terminology and International Classification of Diseases-9\/10 codes, excluding cases for non-LE pathologies. The cohort was divided into diabetics and nondiabetics. Univariate and adjusted multivariable logistic regression analyses were performed.<\/jats:p><jats:p>\n          Results\u2003Among 38,998 patients undergoing LE procedures, 58% were diabetic. Among diabetics, 95% underwent AMP, 5% underwent PF, and &lt;1% underwent FF. Across all procedure types, noninsulin-dependent (NIDDM) and insulin-dependent diabetes mellitus (IDDM) were associated with significantly greater all-cause complication rates compared with absence of diabetes, and IDDM was generally higher risk than NIDDM. Among diabetics, complication rates were not significantly different across procedure types (IDDM: p\u2009=\u20090.5969; NIDDM: p\u2009=\u20090.1902). On adjusted subgroup analysis by diabetic status, flap procedures were not associated with higher odds of complications compared with amputation for IDDM and NIDDM patients. Length of stay\u2009&gt;\u200930 days was statistically associated with IDDM, particularly those undergoing FF (AMP: 5%, PF: 7%, FF: 14%, p\u2009=\u20090.0004).<\/jats:p><jats:p>\n          Conclusion\u2003Our study highlights the importance of preoperative diabetic optimization prior to LE procedures. For diabetic patients, there were few significant differences in complication rates across procedure type, suggesting that diabetic patients are not at higher risk of complications when attempting limb salvage instead of amputation.<\/jats:p>","DOI":"10.1055\/a-2233-2617","type":"journal-article","created":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T00:05:37Z","timestamp":1703117137000},"page":"234-250","source":"Crossref","is-referenced-by-count":8,"title":["Is Diabetes a Contraindication to Lower Extremity Flap Reconstruction? An Analysis of Threatened Lower Extremities in the NSQIP Database (2010\u20132020)"],"prefix":"10.1055","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1950-1169","authenticated-orcid":false,"given":"Amy","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5668-6262","authenticated-orcid":false,"given":"Shannon R.","family":"Garvey","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8715-8713","authenticated-orcid":false,"given":"Nimish","family":"Saxena","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6682-4246","authenticated-orcid":false,"given":"Valeria P.","family":"Bustos","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4283-6984","authenticated-orcid":false,"given":"Emmeline","family":"Jia","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7122-1658","authenticated-orcid":false,"given":"Monica","family":"Morgenstern","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5845-2948","authenticated-orcid":false,"given":"Asha D.","family":"Nanda","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7297-4582","authenticated-orcid":false,"given":"Arriyan S.","family":"Dowlatshahi","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8291-433X","authenticated-orcid":false,"given":"Ryan P.","family":"Cauley","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,1,24]]},"reference":[{"issue":"05","key":"ref2","doi-asserted-by":"crossref","first-page":"917","DOI":"10.2337\/dci18-0007","article-title":"Economic costs of diabetes in the U.S. in 2017","volume":"41","author":"American Diabetes Association","year":"2018","journal-title":"Diabetes Care"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/S0025-7125(16)30854-9","article-title":"Surgery in patients with endocrine dysfunction","volume":"71","author":"D R Goldmann","year":"1987","journal-title":"Med Clin North Am"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1111\/wrr.12694","article-title":"Diabetes is associated with an increased risk of wound complications and readmission in patients with surgically managed pressure ulcers","volume":"27","author":"A R Alfonso","year":"2019","journal-title":"Wound Repair Regen"},{"key":"ref5","first-page":"284063","article-title":"Guidelines for perioperative management of the diabetic patient","volume":"2015","author":"S Sudhakaran","year":"2015","journal-title":"Surg Res Pract"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1016\/S0039-6109(16)43393-1","article-title":"Wound healing with diabetes mellitus. Better glucose control for better wound healing in diabetes","volume":"64","author":"J F McMurry Jr","year":"1984","journal-title":"Surg Clin North Am"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1097\/PRS.0000000000009236","article-title":"Expanding criteria for limb salvage in comorbid patients with nonhealing wounds: The MedStar Georgetown Protocol and Lessons Learned after 200 Lower Extremity Free Flaps","volume":"150","author":"M Nigam","year":"2022","journal-title":"Plast Reconstr Surg"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/01.prs.0000305928.98611.87","article-title":"MOC-PS(SM) CME article: lower extremity reconstruction","volume":"121","author":"V Reddy","year":"2008","journal-title":"Plast Reconstr Surg"},{"issue":"07","key":"ref9","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.3390\/ijms18071419","article-title":"Diabetes and wound angiogenesis","volume":"18","author":"U A Okonkwo","year":"2017","journal-title":"Int J Mol Sci"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.cps.2021.01.004","article-title":"Free tissue transfer for patients with chronic lower extremity wounds","volume":"48","author":"J C Bekeny","year":"2021","journal-title":"Clin Plast Surg"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1097\/PRS.0b013e3182173d3a","article-title":"Foot and ankle reconstruction: pedicled muscle flaps versus free flaps and the role of diabetes","volume":"128","author":"I Ducic","year":"2011","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1097\/00006534-198603000-00018","article-title":"Diabetic foot infections: fate of the contralateral foot","volume":"77","author":"J O Kucan","year":"1986","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref13","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.bjps.2012.09.024","article-title":"Diabetic foot reconstruction using free flaps increases 5-year-survival rate","volume":"66","author":"T S Oh","year":"2013","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"03","key":"ref14","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.ejvs.2010.11.013","article-title":"A systematic review of free tissue transfer in the management of non-traumatic lower extremity wounds in patients with diabetes","volume":"41","author":"E J Fitzgerald O'Connor","year":"2011","journal-title":"Eur J Vasc Endovasc Surg"},{"issue":"08","key":"ref15","doi-asserted-by":"crossref","first-page":"e1461","DOI":"10.1097\/GOX.0000000000001461","article-title":"Defining the association between diabetes and plastic surgery outcomes: an analysis of nearly 40,000 patients","volume":"5","author":"D Goltsman","year":"2017","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"02","key":"ref16","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.jamcollsurg.2017.11.005","article-title":"New 5-Factor Modified Frailty Index using American College of Surgeons NSQIP data","volume":"226","author":"S Subramaniam","year":"2018","journal-title":"J Am Coll Surg"},{"issue":"08","key":"ref17","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.2337\/dc10-0304","article-title":"Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery","volume":"33","author":"A Frisch","year":"2010","journal-title":"Diabetes Care"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1097\/PRS.0b013e3182173d3a","article-title":"Foot and ankle reconstruction: pedicled muscle flaps versus free flaps and the role of diabetes","volume":"128","author":"I Ducic","year":"2011","journal-title":"Plast Reconstr Surg"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"963930","DOI":"10.1155\/2013\/963930","article-title":"Outcomes of diabetic and nondiabetic patients undergoing general and vascular surgery","volume":"2013","author":"S Serio","year":"2013","journal-title":"ISRN Surg"},{"issue":"05","key":"ref20","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1016\/j.surg.2009.10.070","article-title":"Overt diabetes mellitus adversely affects surgical outcomes of noncardiovascular patients","volume":"147","author":"W F Bower","year":"2010","journal-title":"Surgery"},{"issue":"02","key":"ref21","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1097\/PRS.0000000000000861","article-title":"Multidisciplinary approach to soft-tissue reconstruction of the diabetic Charcot foot","volume":"135","author":"J C Sinkin","year":"2015","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref22","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.jdiacomp.2012.12.001","article-title":"Comparison of annual variability in HbA1c and glycated albumin in patients with type 1 vs. type 2 diabetes mellitus","volume":"27","author":"M Koga","year":"2013","journal-title":"J Diabetes Complications"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"k1497","DOI":"10.1136\/bmj.k1497","article-title":"Prevalence of diagnosed type 1 and type 2 diabetes among US adults in 2016 and 2017: population based study","volume":"362","author":"G Xu","year":"2018","journal-title":"BMJ"}],"container-title":["Archives of Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2233-2617.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T11:53:40Z","timestamp":1730807620000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2233-2617"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,20]]},"references-count":22,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2024,4,8]]},"published-print":{"date-parts":[[2024,3]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2233-2617","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2234-6163","2234-6171"],"issn-type":[{"value":"2234-6163","type":"print"},{"value":"2234-6171","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,12,20]]},"published":{"date-parts":[[2023,12,20]]}}}