Outcome of Rotation Flap Combined with Incisional Negative Pressure Wound Therapy for Plantar Diabetic Foot Ulcers

Abstract

Background Diabetic foot ulcers (DFUs) affect approximately 20% of diabetic patients and pose significant risks, especially for plantar wounds that bear weight. Conventional treatments often have suboptimal results, necessitating the exploration of reconstructive options. Plastic surgery interventions, such as skin grafts and flaps, have shown promising outcomes, but with considerable complications. This study evaluates the efficacy of rotation flap reconstruction with incisional negative pressure wound therapy (NPWT) for plantar DFUs.

Methods We conducted a retrospective review of 42 patients who underwent rotation flap closure for plantar DFUs. We optimized the preoperative conditions with aggressive infection control and vascular assessment. We performed rotation flaps with incisional NPWT as the operative technique. We managed the postoperative conditions with offloading continuous incisional NPWT and footwear.

Results All patients achieved initial wound healing, with a median duration of 36 days. Complications occurred in 14% of cases. The recurrence rate was 21% during follow-up, which was significantly higher in patients with Charcot foot deformity. We present three illustrative cases that demonstrate the efficacy of rotation flaps.

Conclusion Rotation flap closure, supplemented by incisional NPWT, emerges as a viable option for plantar DFUs, achieving high initial healing rates, low complications, and reduced recurrence. Notably, patients with Charcot foot deformity require more attention and intervention to prevent recurrence.

Keywords

diabetic ulcer - diabetic limb salvage - local flap - incisional NPWT - plantar

Author Contributions

J.F. and C.B.T. contributed equally to this publication, including conceptualization, methodology, and manuscript preparation. J.W. provided critical input in idea refinement and manuscript revision. Q.M.F.A. and N.T.Y.L. contributed to data collection and manuscript writing. K.Y.C. provided supervision and guidance. The remaining authors were involved in patient management and case contributions. All authors reviewed and approved the final manuscript.

Ethical Approval

Institutional Review Board (IRB ref: 2023/2248) exemption was approved by the IRB board in Sengkang General Hospital for clinical audit.

Patient Consent

Informed consent was obtained from patients to publish their photographs.

^* Jiajun Feng and Coeway Boulder Thng contributed equally to this manuscript.

Publication History

Received: 20 April 2024

Accepted: 18 February 2025

Article published online:
15 May 2025

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