Use of the Anterolateral Thigh Perforator Flap in Diabetic Foot Reconstruction

The purpose of this study was to evaluate the outcome of diabetic foot reconstruction with anterolateral thigh perforator flaps. The study reviewed 71 cases of salvaged diabetic feet over a 52-month period. Patients ranged from 33 to 72 years of age (average: 51 years) with average follow-up of 11 months. The flap survived in all but one reconstructed case, resulting in equivocal findings compared to microvascular free tissue transfer of nondiabetic patients. Early complications such as delayed healing with minor wound dehiscence were seen in 3 cases and partial flap necrosis was seen in 4 cases. Patients with chronic infections were controlled without recurrences. During follow-up, 69 patients achieved the full weight bearing, acceptable contour, and quality of gait prior to diabetic foot complications. A late complication, recurrence of ulceration, was noted in one patient who was blind and unable to perform daily inspection of the foot.

The anterolateral thigh perforator flap provides well-vascularized tissue to control infection, a thin flap to provide one-stage contouring and to minimize shearing, and a skin paddle to resist pressure and improve durability. It can also be combined with vastus lateralis muscle to increase bulk and blood supply for large dead spaces and chronic infections. Anterolateral thigh perforator flaps can be used to achieve acceptable function and aesthetic results in diabetic foot reconstruction.