Use of local intrinsic muscle flaps for diabetic foot and ankle reconstruction: a systematic review

Abstract

Objective: To assess the outcomes of local intrinsic muscle flaps specifically in the surgical reconstruction of foot and ankle wounds in patients with diabetes.

Method: A systematic review of the literature was conducted by three independent reviewers using several databases and search engines. The following search terms were used: foot, ankle, diabetes mellitus, peripheral neuropathy, Charcot neuroarthropathy, ulceration, wound, muscle, flap, surgical offloading, diabetic reconstruction, local intrinsic, abductor digiti minimi, abductor hallucis, extensor digitorum brevis, flexor digitorum brevis, flexor digiti minimi. Studies meeting the following criteria were included: English language studies, studies published from 1997 to 2017 (inclusive of the last 20 years), patients with diabetes treated for foot and/or ankle wounds, use of local intrinsic muscle flaps, follow-up period of six months or more postoperatively, documentation of healing rates, complications, and need for revisional surgery. Studies that were entirely literature reviews, descriptions of only surgical technique and/or cadaveric studies and patients without diabetes were excluded.

Results: A total of 13 selected studies met the above inclusion criteria and were used for data extraction from a total of 113 patients in which 92 local intrinsic muscle flaps were performed for diabetic foot and/or ankle reconstruction, of which 80 (87%) muscle flaps demonstrated success, while 12 (13%) flaps encountered complications.

Conclusion: Although local intrinsic muscle flaps demonstrated a relatively high success rate when used for the definitive closure of certain diabetic foot and ankle wounds based on existing evidence, our systematic review emphasises the need for more high-quality, larger comparative studies to investigate their efficacy and failure rates in diabetic foot and/or ankle reconstruction.

Keywords: ankle; diabetes mellitus; foot; muscle flaps; peripheral neuropathy; reconstruction.