Reconstruction of Wagner Grade 4 diabetic foot ulcers with the superficial circumflex iliac artery perforator free flap

BACKGROUND: Microsurgical free tissue transfers are inevitable for Wagner grade 4 diabetic foot ulcers that cannot be treated conservatively and have a high risk of amputation. In this study, the results of the multidisciplinary management of Wagner grade 4 diabetic foot ulcers and their reconstruction using the SCIP free flap are presented. METHODS: Twenty-one patients with Wagner grade 4 diabetic foot ulcers who underwent reconstruction with the SCIP free flap were retrospectively reviewed. The pain, disability, and activity limitations were evaluated using the foot function index. The foot contour and esthetic satisfaction were evaluated using a 5-point Likert scale. RESULTS: Fifteen patients were male and 6 were female. Reconstruction was performed with chimeric SCIP flaps in five patients and with single-skin-island SCIP flaps in 16 patients. Thirteen flaps were suprafascial and eight were fasciocutaneous. All flaps survived; however, venous congestion (n = 2) and flap dehiscence (n = 2) were observed, which resolved spontaneously within 24 h and were treated conservatively. Seroma (n = 3) and dehiscence (n = 2) were observed in the donor area of fasciocutaneous flaps and treated conservatively with primary suturing. The mean pain, disability, and activity limitation scores were 9 ± 0.7, 8.5 ± 0.5, and 7.9 ± 0.4 preoperatively and 2.3 ± 0.7, 2.2 ± 0.5, and 1.9 ± 0.6 12 months postoperatively, respectively, showing statistically significant improvements (p < 0.001). The foot contour and esthetic satisfaction were excellent (mean Likert score = 5) in patients with suprafascial flaps and good to excellent (mean Likert score = 4.5 ± 0.5) in those with fasciocutaneous flaps, with a statistically significant difference (p = 0.0012). All flaps adapted well to the recipient areas. CONCLUSIONS: Wagner grade 4 diabetic foot ulcers can be salvaged from amputation through multidisciplinary management and advanced microsurgical techniques, and that suprafascial SCIP flaps provide significant advantages in restoring the form and function of diabetic feet owing to their thin structure and the ability to create chimeric designs for multiple defects.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Case series of Wagner Grade 4 diabetic foot ulcer reconstruction with SCIA perforator free flaps — discusses MLT and other adjuncts for venous-congestion management.

Erfahren Sie, wie diese Forschung mit der klinischen Praxis verknüpft ist

More peer-reviewed studies in Arzneimittelentwicklung.

• Novel Leech Antimicrobial Peptides — Hirunipins — Kumar et al. (2025)
• Medicinal Leech Genome Assembly — Anticoagulant Gene Catalog — Kvist et al. (2020)
• Effects of hirudotherapy on liver functions, lipid profile, and insulin sensitivity in rats with metabolic syndrome — Bilden A et al. (2026)
• Hirudotherapy in Medicine and Dentistry — Jha K et al. (2015)
• Medicinal leech therapy (hirudotherapy): a brief overview — Singh A (2010)
• HIRUDOTHERAPY IN PRESBYACUZIS PRAECOX IN CLEAN-UP WORKERS AFTER THE CHORNOBYL ACCIDENT DURING THE POST-CATASTROPHE YEARS — Zabolotnyi D, Mishchanchuk N (2019)
• Investigation of oxidant-antioxidant status in patients treated with hirudotherapy: an experimental study — Sarikan I, Savas H (2024)
• Leech therapeutic applications — Abdualkader A et al. (2013)
• Non-Occlusive Mesenteric Ischemia Due to Hirudotherapy: A Case Report — Akalın Ç, Ekmen N (2020)
• Leech therapy: a history — Hyson J (2005)

Browse all ASH-analysed research →