Published online Nov 6, 2023. doi: 10.12998/wjcc.v11.i31.7570
Peer-review started: September 14, 2023
First decision: September 19, 2023
Revised: September 25, 2023
Accepted: October 23, 2023
Article in press: October 23, 2023
Published online: November 6, 2023
Processing time: 52 Days and 11.7 Hours
Patients with diabetes have lower transcutaneous oxygen pressure (TcpO2) levels than those without diabetes, indicating that poor tissue oxygenation may lead to diabetic foot ulcers (DFUs). TcpO2 measurements can help assess the risk of DFU amputation and the effectiveness of diabetic neuropathy treatment by showing changes in TcpO2 levels.
Vessel anastomosis is challenging in free flap (FF) reconstruction for DFU cases because of atherosclerosis and narrowed vessel. Therefore, it is important to study the benefits of periodic TcpO2 measurement at the FF site of the DFU for a longer period of time.
Our goal was to find out how TcpO2 values changed over time and what it meant for the FF stability. We also wanted to see if TcpO2 measurements were useful for FF reconstruction in DFU patients.
We retrospectively reviewed the records of patients requiring FFs were all defective owing to DFU. In addition to the FF group with DFU patients, a group of DFU patients who did not receive FFs was included as a control group. We then examined how TcpO2 value changed over time.
The FF group had higher levels of ankle-brachial index (ABI), haemoglobin, creatinine, diabetes mellitus duration, and C-reactive protein than the control group. Both groups had low TcpO2 levels. TcpO2 levels increased gradually in the short term, but decreased gradually in the long term (after postoperative day 30).
There is no significant increase in TcpO2 was noted even after a long-term follow-up of > 1 year. This may be due to the flap thickness, the sympathectomy from adventitia removal, and the diabetic arteriovenous (AV) shunts. Therefore, TcpO2 measurements may not be very helpful for FF reconstruction in DFU patients, unlike in DFU patients who did not have FF reconstruction, because of the features of FF surgery and DFU.
Future studies should measure TcpO2 more frequently. A larger and multi-center study with more patients is needed. A prospective study may also confirm the risk factors we found for TcpO2 pattern analysis. Especially, sympathectomy and AV shunt formation, which may cause low TcpO2, need more experiments than just TcpO2 or ABI measurements.