Salvataje de extremidad inferior en diabéticos: trasplante muscular microquirúrgico con y sin reconstrucción vascular previa / Salvage of low extremity in diabetics: microsurgical muscular transplantation with and without previous vascular reconstruction

ABSTRACT

Soft tissue wounds with or without bony involvement are a common problem and a cause of limb loss in diabetics. Usually local care, antibiotics, minor debridement and skin grafting are enough for successful handling of these lesions. When there proximal bony involvement and tendom exposure, the incidence of primary amputation rises, frequently being considered the only alternative. Two cases of diabetic patients with indication of primary amputation of a lower limb for large infected ulcers are reported. A microvascularized muscle transplant wa sused to cover large defects of soft tissue, tendoms and infected bone. One patient presented also critical ischaemia of the limb, requiring iliac angioplasty and a femoro-distal by-pass with in situ greater saphenous vein previous to the muscle graft. Both patients had no postoperative complications, being able to walk two months after the operation with their useful limb. Microvascularized muscle transplant with or without revascularization is a very useful alternative to amputation in the management of complex wounds of selected diabetic patients