Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2023; 11(31): 7570-7582
Published online Nov 6, 2023. doi: 10.12998/wjcc.v11.i31.7570
Does the advantage of transcutaneous oximetry measurements in diabetic foot ulcer apply equally to free flap reconstruction?
Da Woon Lee, Yong Seon Hwang, Je Yeon Byeon, Jun Hyuk Kim, Hwan Jun Choi
Da Woon Lee, Yong Seon Hwang, Je Yeon Byeon, Jun Hyuk Kim, Hwan Jun Choi, Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
Author contributions: Lee DW and Choi HJ contributed to the conceptualization and methodology of this study; Lee DW participated in the formal analysis, visualization, and writing-original draft preparation of this article; Byeon JY and Hwang YS involved in the investigation of this manuscript; Byeon JY and Kim JH contributed to the resources; Lee DW and Hwang YS participated in the data curation; Kim JH and Choi HJ contributed to the supervision; Choi HJ contributed to the project administration and funding acquisition; and all authors have read and agreed to the published version of the manuscript.
Supported by the National Research Foundation of Korea Grant funded by the Korean government (MSIT) (2020R1A2C1100891 and 2021R1G1A1008337); and the Soonchunhyang University Research Fund.
Institutional review board statement: The study protocol was approved by the Institutional Review Board (number:2022-12-043-003).
Informed consent statement: The patient provided informed consent for the publication.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data are available from the authors upon reasonable request.
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: Hwan Jun Choi, MD, PhD, Professor, Surgeon, Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Suncheonhyang 6-gil 31, Dongnam-gu, Cheonan-si 31151, South Korea. iprskorea@gmail.com
Received: September 14, 2023
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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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).

Research conclusions

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.

Research perspectives

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.