Microvascular Reconstruction in the Revascularised Diabetic
Background and Introduction : Now there is increasing occurrence of diabetic foot with ongoing epidemic of diabetes mellitus throughout the world. Considerably there is also increase in the critically ischemic diabetic foot which requires timely recognition, timely revascularization and last but not the least timely reconstruction. In this article author describes his perforosomal approach for the microvascular reconstruction in the revascularised diabetic foot. This thoughtful applied anatomical approach is pursued right from the recognition of critical ischemia. It begins with assessment of perforosomes involved by ischemia and subsequently perforosomal directed distal revascularization (PDDR) and then perforosome directed reconstruction. Plastic surgeon coordinates with interventional radiologists or vascular surgeon to pursue direct distal revascularization of all involved perforosomes. Finally this culminated in the perforosomal approach for the reconstruction, which results in shoeable and stable foot or foot residuum in all cases. Altered vasohemodynamics peculiar to the revascularised diabetic foot called “Regional vascular insufficiency” (RVI) also discussed in this article.

Materials and Method : This is prospective cohort study with level II evidence conducted with 50 (age 44 to 68and M: F ratio 40:10) critically ischemic diabetic foot patients (ABI <or= 0.7) with no healing potential. All had undergone PDDR followed by microvascular reconstruction during March 2011 to March 2016. All patients were followed for on average period of 18 months post reconstruction. The outcomes were analyzed in terms of, averagelatency period (between the revascularization and reconstruction contributed by regional vascular insufficiency) as a measure of effectiveness of PDDR, and then factors like ambulation capabilities attained, length of hospital stay and rate of recurrence of ulcers as the measure of effectiveness of microvascular reconstruction (MVR). All patients also underwent many adjuvant procedures (internal offloading) as an integral part of MVR. Complications related to PDDR and MVR are also analyzed.

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