Reconstruction of the diabetic foot using the anterolateral thigh perforator flap

Background: The purpose of this study was to evaluate the outcome of the diabetic foot reconstructed with the anterolateral thigh perforator flap. Methods: This study reviews 71 cases of salvaged diabetic foot over a 52-month period. Patients ranged in age from 33 to 72 years (average, 51 years), with an average follow-up of 11 months. Results: Flaps survived in all but one reconstructed case, resulting in equivocal findings compared with microvascular free tissue transfer of nondiabetic patients. Early complications such as delayed healing with minor wound dehiscence were seen in three cases, and partial flap necrosis was seen in four cases. Patients with chronic infections were controlled without recurrences. During the follow-up, 69 patients achieved full weight bearing, acceptable contour, and quality of gait before diabetic foot complications. However, late complications such as recurrence of ulceration was noted in one patient, who was blind and unable to perform daily inspection of the foot. Conclusions: The anterolateral thigh perforator flap provides well-vascularized tissue that controls infection, a thin flap that provides one-stage contouring and minimizes shearing, and a skin paddle that resists pressure and improves durability. The flap can also be combined with vastus lateralis muscle to increase bulk and blood supply against large dead spaces and chronic infections. Anterolateral thigh perforator flaps can be used to achieve acceptable function and aesthetic results for diabetic foot reconstruction.