A study of the survival factors of free flap in older diabetic patients.

We investigated the reconstruction of feet in older diabetic patients, assessing the factors that affect the survival of transplantation tissue and successful transplantation with a prospective survey. From October 2004 to December 2005, the patients, who underwent reconstruction of diabetic feet with an anterolateral thigh perforator free flap, were all over 55 years old at the time of operation. We performed hematologic, hemodynamic, diabetic, bacteriologic, and radiological tests prior to the surgery, evaluating the condition of blood vessels at the donor site and the recipient site and the condition of transplantation tissues. After the surgery, we determined the survival or death of transplantation tissue. Fifteen of 16 patients were evaluated. In one case, transplantation failed, and in four cases, partial graft tissue-necrosis occurred. All assayed terms of the patients and the chart were similar except for peak blood flow velocity (PBFV), which was measured by Doppler ultrasonography at the artery recipient site. The PBFV in failed patients was 20 cm/s. In cases of delayed wound-healing, the PBFV was 30 cm/s. All patients with PBFVs over 40 cm/s had successful results. So using free flap transplantation to remedy diabetic foot ulcers can produce excellent or good results, especially in patients with PBFVs over 40 cm/s at the recipient artery.