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당뇨발 절단 치료에서 Fillet Flap의 사용

Fillet Flap Coverage for Closure of Diabetic Foot Amputation

대한족부족관절학회지 2020년 24권 4호 p.148 ~ 155
이정우, 유환, 박재용,
소속 상세정보
이정우 ( Lee Jung-Woo ) - Hallym University College of Medicine Hallym Sacred Heart Hospital Department of Orthopaedic Surgery
유환 ( Ryu Hwan ) - Hallym University College of Medicine Hallym Sacred Heart Hospital Department of Orthopaedic Surgery
박재용 ( Park Jae-Yong ) - Hallym University College of Medicine Hallym Sacred Heart Hospital Department of Orthopaedic Surgery

Abstract


Purpose: Minor foot amputations are performed for recurrent or infected ulcers or osteomyelitis of the diabetic feet. Patients may re?quire a large amount of bone resection for wound closure. On the other hand, this results in more foot dysfunction and a longer time to heal. The authors describe fillet flap coverage to avoid more massive resection in selected cases. This study shows the results of fillet flap coverage for the closure of diabetic foot minor amputation.

Materials and Methods: This was a retrospective case series of patients who underwent forefoot and midfoot amputation and fillet flap for osteomyelitis or nonhealing ulcers between March 2013 to November 2017. In addition, the patient comorbidities, hospital days, complications, and duration to complete healing were evaluated.

Results: Fourteen fillet flap procedures were performed on 12 patients. Of those, two had toe necrosis, nine had forefoot necrosis, and three had midfoot necrosis. Eleven forefoot amputations and three midfoot amputations were performed. Among forefoot necrosis af?ter a fillet flap, three patients had revision surgery for partial necrosis of the flap, and two patients had an additional amputation. Two patients had additional amputations among those with midfoot necrosis. By the fillet flap, the amputation size was reduced as much as possible. The mean initial healing days, complete healing days, and hospital stay was 70.6 days, 129.0 days, and 60.0 days, respectively.

Conclusion: The fillet flap facilitates restoration of the normal foot contour and allows salvage of the metatarsal or toe.

키워드

Diabetic feet; Amputation; Limb salvage; Surgical flaps; Wound closure techniques

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