Wu HL, Huang H, Chen BQ, Xia J, Jiang LB. Intraoperative blood perfusion factors in free anterolateral thigh flap repair for diabetic foot ulcers: A retrospective analysis. World J Diabetes 2025; 16(8): 105532 [DOI: 10.4239/wjd.v16.i8.105532]
Corresponding Author of This Article
Li-Bing Jiang, Department of Orthopaedics, The First Hospital of Nanchang, No. 128 Xiangshan North Road, Donghu, Nanchang 330008, Jiangxi Province, China. lijoy1126@163.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Case Control Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hong-Liang Wu, Huan Huang, Bin-Qi Chen, Jian Xia, Li-Bing Jiang, Department of Orthopaedics, The First Hospital of Nanchang, Nanchang 330008, Jiangxi Province, China
Author contributions: Jiang LB designed the experiments and conducted clinical data collection; Huang H, Chen BQ and Xia J performed postoperative follow-up and recorded the data; Wu HL and Jiang LB conducted the collation and statistical analysis, and wrote the original manuscript and revised the paper; All authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the First Hospital of Nanchang, No. IIT2024018.
Informed consent statement: The ethics committee agrees to waive informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: All data generated or analyzed during this study are included in this published article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Bing Jiang, Department of Orthopaedics, The First Hospital of Nanchang, No. 128 Xiangshan North Road, Donghu, Nanchang 330008, Jiangxi Province, China. lijoy1126@163.com
Received: February 18, 2025 Revised: April 9, 2025 Accepted: July 4, 2025 Published online: August 15, 2025 Processing time: 177 Days and 3 Hours
Abstract
BACKGROUND
Diabetic foot ulcers (DFUs) in patients with type 2 diabetes (T2D) are associated with heightened risks of infection and amputation and thus require effective surgical interventions to enhance outcomes. Free anterolateral thigh (ALT) perforator flap is a promising reconstructive method; however, diabetic vasculopathy challenges optimal perfusion. This study analyzes factors influencing intraoperative blood perfusion in ALT flap repair for DFUs.
AIM
To identify key factors affecting intraoperative blood perfusion during free ALT perforator flap repair in patients with T2D and DFUs, thereby providing insights to improve surgical outcomes.
METHODS
This retrospective case-control study included 100 patients with T2D who underwent ALT flap repair at our institution between June 2016 and June 2024. Patients were categorized into normal (n = 50) and abnormal (n = 50) blood perfusion groups based on intraoperative perfusion assessments. Data on demographics, clinical characteristics, vascular status, metabolic control, and preoperative laboratory parameters were collected. Statistical analyses, including univariate and multivariate logistic regression, were conducted to identify significant predictive factors for perfusion outcomes.
RESULTS
Old age, high body mass index, long diabetes duration, and presence of diabetic peripheral neuropathy were associated with impaired perfusion. Abnormal perfusion was correlated with poor ankle-brachial index and elevated glycated hemoglobin (HbA1c), creatinine, triglycerides, and partial pressure of carbon dioxide. Conversely, high hemoglobin, albumin, and prealbumin levels and partial pressure of oxygen (PaO2) were protective. Multivariate analysis identified diabetes duration, HbA1c, PaCO2, PaO2, and albumin as independent predictors of perfusion, underscoring the roles of metabolic control and vascular health.
CONCLUSION
Optimizing metabolic control, vascular health, and nutritional status was crucial to enhance intraoperative blood perfusion in diabetic patients undergoing ALT perforator flap repair for DFUs.
Core Tip: This study investigates the key factors influencing intraoperative blood perfusion in patients with type 2 diabetes undergoing free anterolateral thigh perforator flap repair for diabetic foot ulcers. We identified that prolonged diabetes duration, elevated glycated hemoglobin, and poor nutritional status significantly impair perfusion. Conversely, higher hemoglobin, albumin, and prealbumin levels were protective. These findings underscore the importance of integrated diabetes management strategies, including metabolic control and nutritional support, to optimize surgical outcomes. Prospective studies are needed to validate these results and refine perioperative care protocols for improved patient outcomes.
