Flaps for Lower Limb Diabetic Wound Reconstruction: A Systematic Review of Surgical Outcomes and Techniques: Flaps for Lower Limb Diabetic Wound Reconstruction

Devina Swantara; Aquarina Sukahar; Andi Muhammad Ardan

doi:10.59747/smjidisurabaya.v3i2.126

Authors

Devina Swantara Adhyaksa Clinic, East Java High's Prosecutor's Office https://orcid.org/0009-0004-5812-2286
Aquarina Ashari Sukahar Meloy Regional Hospital, Sangatta, Indonesia https://orcid.org/0009-0001-1671-3828
Andi Muhammad Ardan Plastic Reconstructive and Aesthetic Surgery Division, Universitas Mulawarman, Abdoel Wahab Sjahranie General Hospital, Samarinda, Indonesia https://orcid.org/0000-0002-6105-2985

DOI:

https://doi.org/10.59747/smjidisurabaya.v3i2.126

Keywords:

Diabetes, Diabetic foot, Health care, Limb salvage, Surgical flaps

Abstract

Background: Diabetic foot ulcers (DFUs) are a major cause of limb loss and mortality. Flap reconstruction is a vital limb salvage technique, but comparative evidence remains limited. Objective: This review evaluates outcomes across flap types and identifies factors influencing success.

Material and Method: A systematic search of five databases identified clinical studies (≥5 patients) reporting outcomes of flap reconstruction for non-traumatic DFUs. Data on patient demographics, flap characteristics, and clinical outcomes were extracted. Study quality was assessed using the ROBINS-I tool.

Result: Twenty studies were included. Free flaps were common for complex wounds, with survival rates of 88–93% and limb salvage rates of 79–95%, but had a 19% major complication rate. Locoregional flaps showed lower failure rates (3–5%) but risked venous congestion and partial necrosis. Fasciocutaneous flaps had fewer wound complications than muscle flaps (7.3% vs. 19.1%) and offered better sensory recovery and faster weight-bearing.

Conclusion: Flap reconstruction is effective for DFU limb salvage. No single flap is superior; individualized selection is essential. Future studies should prioritize standardized, long-term, patient-centered outcomes to guide clinical decisions.

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Flaps for Lower Limb Diabetic Wound Reconstruction: A Systematic Review of Surgical Outcomes and Techniques