{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T13:10:35Z","timestamp":1784121035866,"version":"3.55.0"},"reference-count":62,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T00:00:00Z","timestamp":1764374400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Complex diabetic foot ulcers (DFUs) are a leading cause of morbidity and lower-limb amputation, and their management is profoundly challenging. Microvascular free tissue transfer is a primary limb salvage strategy, with the anterolateral thigh (ALT) free-flap recognized as a workhorse reconstructive solution. However, a quantitative summary of its performance specifically within this high-risk patient population is lacking. Methods: A systematic review and single-arm meta-analysis was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Five electronic databases (PubMed\/MEDLINE, Embase, Scopus, Cochrane, and Web of Science Core Collection) were searched up to 9 September 2025 to identify studies reporting on outcomes of ALT free-flaps for diabetic foot reconstruction. The risk of bias was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Primary outcomes were set as the complete and partial flap necrosis rate. Secondary outcomes included functional recovery status and complication rates. All data were synthesized using a random-effects model. Results: Six retrospective cohort studies met the inclusion criteria, including a total of 162 patients. The pooled rate of total flap failure was 5.2% (95% CI: 2.5\u201310.6%), a finding that was highly consistent across all studies (I2 = 0%). The pooled incidence of partial flap necrosis was 13.0% (95% CI: 6.3\u201325.1%), resulting in an overall weighted flap success rate of 81.8%. Notably, the pooled rate of return to ambulation was 95.2% (95% CI: 88.5\u201398.1%), which also demonstrated no statistical heterogeneity (I2 = 0%). Conclusions: The anterolateral thigh free-flap appears to be a robust and highly reliable strategy for diabetic foot reconstruction, associated with low failure rates, minimal long-term complications, and excellent functional recovery. However, the current evidence is limited to a small number of poor-to-moderate-quality retrospective studies. High-quality, prospective, and comparative multicenter trials are necessary to confirm these findings and establish the ALT flap\u2019s effectiveness in high-risk cohorts.<\/jats:p>","DOI":"10.3390\/jcm14238481","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:20:29Z","timestamp":1765210829000},"page":"8481","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A Systematic Review and Meta-Analysis of Anterolateral Thigh Flap Outcomes in High-Risk Diabetic Foot Reconstruction"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7435-7196","authenticated-orcid":false,"given":"Abdalah","family":"Abu-Baker","sequence":"first","affiliation":[{"name":"Doctoral School, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 010221 Bucharest, Romania"},{"name":"Discipline of Plastic Surgery, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 010221 Bucharest, Romania"},{"name":"Department of Plastic Surgery, \u201cProf. Dr. Agrippa Ionescu\u201d Emergency Clinical Hospital, 011356 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrada-Elena","family":"\u0162ig\u0103ran","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 010221 Bucharest, Romania"},{"name":"Discipline of Plastic Surgery, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 010221 Bucharest, Romania"},{"name":"Department of Plastic Surgery, \u201cProf. Dr. Agrippa Ionescu\u201d Emergency Clinical Hospital, 011356 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teodora","family":"Timofan","sequence":"additional","affiliation":[{"name":"Discipline of Plastic Surgery, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 010221 Bucharest, Romania"},{"name":"Department of Plastic Surgery, \u201cProf. Dr. Agrippa Ionescu\u201d Emergency Clinical Hospital, 011356 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela-Elena","family":"Ion","sequence":"additional","affiliation":[{"name":"Discipline of Plastic Surgery, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 010221 Bucharest, Romania"},{"name":"Department of Plastic Surgery, \u201cProf. Dr. Agrippa Ionescu\u201d Emergency Clinical Hospital, 011356 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8603-5807","authenticated-orcid":false,"given":"Daniela-Elena","family":"Gheoca-Mutu","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, \u201cProf. Dr. Agrippa Ionescu\u201d Emergency Clinical Hospital, 011356 Bucharest, Romania"},{"name":"Discipline of Anatomy, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 010221 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adelaida","family":"Avino","sequence":"additional","affiliation":[{"name":"Discipline of Plastic Surgery, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 010221 Bucharest, Romania"},{"name":"Department of Plastic Surgery, \u201cProf. Dr. Agrippa Ionescu\u201d Emergency Clinical Hospital, 011356 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian Daniel","family":"Tulin","sequence":"additional","affiliation":[{"name":"Discipline of Anatomy, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 010221 Bucharest, Romania"},{"name":"Department of General Surgery, \u201cProf. Dr. Agrippa Ionescu\u201d Emergency Clinical Hospital, 011356 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9376-6774","authenticated-orcid":false,"given":"Laura","family":"Raducu","sequence":"additional","affiliation":[{"name":"Discipline of Plastic Surgery, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 010221 Bucharest, Romania"},{"name":"Department of Plastic Surgery, \u201cProf. Dr. Agrippa Ionescu\u201d Emergency Clinical Hospital, 011356 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian-Radu","family":"Jecan","sequence":"additional","affiliation":[{"name":"Discipline of Plastic Surgery, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 010221 Bucharest, Romania"},{"name":"Department of Plastic Surgery, \u201cProf. Dr. Agrippa Ionescu\u201d Emergency Clinical Hospital, 011356 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e59571","DOI":"10.2196\/59571","article-title":"Prevalence, Awareness, Treatment, and Control of Type 2 Diabetes in South Korea (1998 to 2022): Nationwide Cross-Sectional Study","volume":"10","author":"Jang","year":"2024","journal-title":"JMIR Public Health Surveill."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.diabres.2018.02.023","article-title":"IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045","volume":"138","author":"Cho","year":"2018","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Lin, X., Xu, Y., Pan, X., Xu, J., Ding, Y., Sun, X., Song, X., Ren, Y., and Shan, P.F. (2020). Global, regional, and national burden and trend of diabetes in 195 countries and territories: An analysis from 1990 to 2025. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-71908-9"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1177\/2047487319881021","article-title":"The global epidemics of diabetes in the 21st century: Current situation and perspectives","volume":"26","author":"Standl","year":"2019","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Safiri, S., Karamzad, N., Kaufman, J.S., Bell, A.W., Nejadghaderi, S.A., Sullman, M.J.M., Moradi-Lakeh, M., Collins, G., and Kolahi, A.-A. (2022). Prevalence, Deaths and Disability-Adjusted-Life-Years (DALYs) Due to Type 2 Diabetes and Its Attributable Risk Factors in 204 Countries and Territories, 1990-2019: Results From the Global Burden of Disease Study 2019. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.838027"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.jcot.2021.01.017","article-title":"The current burden of diabetic foot disease","volume":"17","author":"Edmonds","year":"2021","journal-title":"J. Clin. Orthop. Trauma"},{"key":"ref_7","first-page":"1","article-title":"Diabetic Foot Ulcer\u2014A clinical study","volume":"7","author":"Wadhawan","year":"2025","journal-title":"Int. J. Multidiscip. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"209","DOI":"10.2337\/dci22-0043","article-title":"Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers","volume":"46","author":"McDermott","year":"2023","journal-title":"Diabetes Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1111\/nyas.13569","article-title":"Update on management of diabetic foot ulcers","volume":"1411","author":"Everett","year":"2018","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Fan, Z., Liu, Y., Xie, H., Yang, Q., Zhang, G., Zhang, P., and Ding, H. (2025). Analysis of risk factors for foot ulcers in diabetes patients with neurovascular complications. BMC Public Health, 25.","DOI":"10.1186\/s12889-025-21639-1"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e3686","DOI":"10.1002\/dmrr.3686","article-title":"The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes and a foot ulcer","volume":"40","author":"Fitridge","year":"2024","journal-title":"Diabetes\/Metabolism Res. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Piran, N., Farhadian, M., Soltanian, A.R., and Borzouei, S. (2024). Diabetic foot ulcers risk prediction in patients with type 2 diabetes using classifier based on associations rule mining. Sci. Rep., 14.","DOI":"10.1038\/s41598-023-47576-w"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1021\/acs.accounts.0c00864","article-title":"Strategy for Treatment of Infected Diabetic Foot Ulcers","volume":"54","author":"Chang","year":"2021","journal-title":"Accounts Chem. Res."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Lin, C.-W., Hung, C.-M., Chen, W.-J., Chen, J.-C., Huang, W.-Y., Lu, C.-S., Kuo, M.-L., and Chen, S.-G. (2022). New Horizons of Macrophage Immunomodulation in the Healing of Diabetic Foot Ulcers. Pharmaceutics, 14.","DOI":"10.3390\/pharmaceutics14102065"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"115120","DOI":"10.1016\/j.addr.2023.115120","article-title":"Thou shall not heal: Overcoming the non-healing behaviour of diabetic foot ulcers by engineering the inflammatory microenvironment","volume":"203","author":"Monaghan","year":"2023","journal-title":"Adv. Drug Deliv. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Afonso, A.C., Oliveira, D., Saavedra, M.J., Borges, A., and Sim\u00f5es, M. (2021). Biofilms in Diabetic Foot Ulcers: Impact, Risk Factors and Control Strategies. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22158278"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Abu-Baker, A., \u0162ig\u0103ran, A.-E., Timofan, T., Ion, D.-E., Gheoca-Mutu, D.-E., Avino, A., Marina, C.-N., Tulin, A.D., Raducu, L., and Jecan, R.-C. (2025). Mapping Perfusion and Predicting Success: Infrared Thermography-Guided Perforator Flaps for Lower Limb Defects. Medicina, 61.","DOI":"10.3390\/medicina61081410"},{"key":"ref_18","first-page":"1","article-title":"Diagnosis and management of diabetic foot complications","volume":"2018","author":"Boulton","year":"2018","journal-title":"Diabetes"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e232","DOI":"10.1161\/CIR.0000000000001192","article-title":"Current Status and Principles for the Treatment and Prevention of Diabetic Foot Ulcers in the Cardiovascular Patient Population: A Scientific Statement From the American Heart Association","volume":"149","author":"Gallagher","year":"2024","journal-title":"Circulation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1016\/S0140-6736(03)13169-8","article-title":"Diabetic foot ulcers","volume":"361","author":"Jeffcoate","year":"2003","journal-title":"Lancet"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"21.e1","DOI":"10.1016\/j.jaad.2013.07.048","article-title":"Diabetic foot ulcers","volume":"70","author":"Alavi","year":"2014","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"645","DOI":"10.2337\/dc17-1836","article-title":"Current Challenges and Opportunities in the Prevention and Management of Diabetic Foot Ulcers","volume":"41","author":"Jeffcoate","year":"2018","journal-title":"Diabetes Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1016\/j.ejvs.2023.07.031","article-title":"Free Tissue Transfer in Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis","volume":"66","author":"Bhat","year":"2023","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1097\/PRS.0000000000011231","article-title":"Outcomes of Flap Reconstruction for Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis of Clinical Studies","volume":"154","author":"Reed","year":"2024","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_25","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":"Nigam","year":"2022","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1097\/PRS.0000000000007644","article-title":"Amputation versus Free Flap: Long-Term Outcomes of Microsurgical Limb Salvage and Risk Factors for Amputation in the Diabetic Population","volume":"147","author":"Kotha","year":"2021","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Felder, J.M., Orr, J., Schott, H.B., and Geraghty, P. (2025). Objective grading of peripheral vascular disease strongly predicts morbidity in microsurgical lower limb salvage. Plast. Reconstr. Surg.","DOI":"10.1097\/PRS.0000000000012246"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/j.ejvs.2018.11.010","article-title":"Editor\u2019s Choice\u2014Diabetic Limb Salvage with Endovascular Revascularisation and Free Tissue Transfer: Long-Term Follow up","volume":"57","author":"Chang","year":"2019","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_29","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":"Vesely","year":"2011","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.ejvs.2015.04.004","article-title":"Strategies for Free Flap Transfer and Revascularisation with Long-term Outcome in the Treatment of Large Diabetic Foot Lesions","volume":"50","author":"Kallio","year":"2015","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"S32","DOI":"10.1016\/j.injury.2019.10.045","article-title":"Selecting a free flap for soft tissue coverage in lower extremity reconstruction","volume":"50","author":"Kozusko","year":"2019","journal-title":"Injury"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1097\/01.prs.0000244856.98170.9c","article-title":"Sole Reconstruction Using Anterolateral Thigh Perforator Free Flaps","volume":"119","author":"Hong","year":"2007","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Lee, Y.J., Kim, J., Lee, C.R., Kim, J.H., Oh, D.Y., Jun, Y.J., and Moon, S.-H. (2023). Anterolateral Thigh Chimeric Flap: An Alternative Reconstructive Option to Free Flaps for Large Soft Tissue Defects. J. Clin. Med., 12.","DOI":"10.3390\/jcm12216723"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1071e","DOI":"10.1097\/PRS.0000000000009646","article-title":"Risk Factors for Partial Flap Loss in a Free Flap: A 12-Year Retrospective Study of Anterolateral Thigh Free Flaps in 303 Lower Extremity Cases","volume":"150","author":"Min","year":"2022","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan\u2014A web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst. Rev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1046\/j.1445-2197.2003.02748.x","article-title":"Methodological index for non-randomized studies (MINORS): Development and validation of a new instrument","volume":"73","author":"Slim","year":"2003","journal-title":"ANZ J. Surg."},{"key":"ref_38","unstructured":"The Jamovi Project (2025, September 13). Jamovi, Available online: https:\/\/www.jamovi.org."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.jclinepi.2010.04.026","article-title":"GRADE guidelines: 1. Introduction\u2014GRADE evidence profiles and summary of findings tables","volume":"64","author":"Guyatt","year":"2011","journal-title":"J. Clin. Epidemiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1097\/01.PRS.0000138750.54859.AC","article-title":"The Use of Anterolateral Thigh Perforator Flaps in Chronic Osteomyelitis of the Lower Extremity","volume":"115","author":"Hong","year":"2005","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1599","DOI":"10.1097\/01.prs.0000207057.16292.8f","article-title":"Reconstruction of the Diabetic Foot Using the Anterolateral Thigh Perforator Flap","volume":"117","author":"Hong","year":"2006","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1055\/s-2007-992345","article-title":"A Study of the Survival Factors of Free Flap in Older Diabetic Patients","volume":"23","author":"Lee","year":"2007","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1055\/s-0036-1579536","article-title":"Microsurgical Reconstruction of Plantar Ulcers of the Insensate Foot","volume":"32","author":"Kadam","year":"2016","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1186\/s13018-024-05122-y","article-title":"Clinical effects of different types of flaps selected according to local conditions in the treatment of diabetic foot defects","volume":"19","author":"Yang","year":"2024","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"102176","DOI":"10.1016\/j.foot.2025.102176","article-title":"Clinical evaluation of orthoplastic limb salvage protocol using anterolateral femoral free flap and kickstand fixation: A retrospective case-control study","volume":"63","author":"Wen","year":"2025","journal-title":"Foot"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1097\/00003086-198904000-00017","article-title":"Ilizarov Treatment of Tibial Nonunions with Bone Loss","volume":"241","author":"Paley","year":"1989","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1177\/107110079401500701","article-title":"Clinical Rating Systems for the Ankle-Hindfoot, Midfoot, Hallux, and Lesser Toes","volume":"15","author":"Kitaoka","year":"1994","journal-title":"Foot Ankle Int."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1097\/PRS.0000000000001891","article-title":"A Systematic Review and Meta-Analysis of Perforator-Pedicled Propeller Flaps in Lower Extremity Defects","volume":"137","author":"Bekara","year":"2016","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"S16","DOI":"10.1016\/j.injury.2020.03.014","article-title":"Reverse neurocutaneous vs propeller perforator flaps in diabetic foot reconstruction","volume":"51","author":"Demiri","year":"2020","journal-title":"Injury"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Hutting, K.H., de Stegge, W.B.A., van Netten, J.J., Cate, W.A.T., Smeets, L., Welten, G.M.J.M., Scharn, D.M., de Vries, J.-P.P.M., and van Baal, J.G. (2021). Surgical Treatment of Diabetic Foot Ulcers Complicated by Osteomyelitis with Gentamicin-Loaded Calcium Sulphate-Hydroxyapatite Biocomposite. J. Clin. Med., 10.","DOI":"10.3390\/jcm10020371"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Kavarthapu, V., Giddie, J., Kommalapati, V., Casey, J., Bates, M., and Vas, P. (2023). Evaluation of Adjuvant Antibiotic Loaded Injectable Bio-Composite Material in Diabetic Foot Osteomyelitis and Charcot Foot Reconstruction. J. Clin. Med., 12.","DOI":"10.3390\/jcm12093239"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"5551","DOI":"10.1007\/s00784-021-03883-y","article-title":"Correction to: Perioperative predictors of early surgical revision and flap-related complications after microvascular free tissue transfer in head and neck reconstructions: A retrospective observational series","volume":"25","author":"Burkhard","year":"2021","journal-title":"Clin. Oral Investig."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1759720X231189008","DOI":"10.1177\/1759720X231189008","article-title":"New insights in lower limb reconstruction strategies","volume":"15","author":"Toro","year":"2023","journal-title":"Ther. Adv. Musculoskelet. Dis."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Yan, X., Song, J.-F., Zhang, L., and Li, X. (2022). Analysis of risk factors for multidrug-resistant organisms in diabetic foot infection. BMC Endocr. Disord., 22.","DOI":"10.1186\/s12902-022-00957-0"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.ekir.2021.12.018","article-title":"Narrative Review of the Relationship Between CKD and Diabetic Foot Ulcer","volume":"7","author":"Bonnet","year":"2022","journal-title":"Kidney Int. Rep."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Vacaroiu, I.A., Cuiban, E., Geavlete, B.F., Gheorghita, V., David, C., Ene, C.V., Bulai, C., Lupusoru, G.E., Lupusoru, M., and Balcangiu-Stroescu, A.E. (2022). Chronic Kidney Disease\u2014An Underestimated Risk Factor for Antimicrobial Resistance in Patients with Urinary Tract Infections. Biomedicines, 10.","DOI":"10.3390\/biomedicines10102368"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.12998\/wjcc.v11.i7.1506","article-title":"Accessory renal arteries\u2014A source of hypertension: A case report","volume":"11","author":"Calinoiu","year":"2023","journal-title":"World J. Clin. Cases"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.jvs.2015.02.051","article-title":"The association of chronic kidney disease and dialysis treatment with foot ulceration and major amputation","volume":"62","author":"Otte","year":"2015","journal-title":"J. Vasc. Surg."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e70415","DOI":"10.14814\/phy2.70415","article-title":"The combined impact of chronic kidney disease and ulcer severity on incident cardiovascular events in patients with diabetes-related foot ulceration","volume":"13","author":"Lan","year":"2025","journal-title":"Physiol. Rep."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.2337\/dc21-2218","article-title":"The Use of Point-of-Care Bacterial Autofluorescence Imaging in the Management of Diabetic Foot Ulcers: A Pilot Randomized Controlled Trial","volume":"45","author":"Rahma","year":"2022","journal-title":"Diabetes Care"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e2122607","DOI":"10.1001\/jamanetworkopen.2021.22607","article-title":"Effect of a Novel Macrophage-Regulating Drug on Wound Healing in Patients With Diabetic Foot Ulcers","volume":"4","author":"Huang","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e14900","DOI":"10.1111\/iwj.14900","article-title":"Combining antibiotic-loaded bone cement-based free vastus lateralis muscle-sparing flap with split-thickness skin grafts: A reliable strategy for reconstructing diabetic foot ulcers at non-weight-bearing areas","volume":"21","author":"Chang","year":"2024","journal-title":"Int. Wound J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/23\/8481\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:25:28Z","timestamp":1765211128000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/23\/8481"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,29]]},"references-count":62,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14238481"],"URL":"https:\/\/doi.org\/10.3390\/jcm14238481","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,29]]}}}