Mini Free Flaps for Diabetic Foot Reconstruction

Background: Diabetic foot ulcers (DFUs) frequently lead to infections, amputations, and reduced quality of life and therefore limb salvage through flap reconstruction plays a crucial role. However, challenges arise in cases requiring soft tissue to cover the metatarsal head or dead space above the amputation stump. This study aims to assess the importance and effectiveness of mini free flap reconstruction for small DFUs to prevent further amputations and preserve foot length. Methods: A retrospective review was conducted of DFU patients who underwent mini free flap reconstruction. Preoperative evaluation included CT angiography and high-frequency ultrasonography to assess recipient vessel status and guide flap design. Mini free flaps were harvested and anastomosed to recipient vessels selected from smaller distal arteries rather than major vessels. Results: A total of 20 patients underwent mini free flap reconstruction. The average wound size was 6.8 cm². The mini flap types included superficial circumflex iliac artery perforator, superficial inferior epigastric artery, anterior tibial artery, and peroneal artery perforator flap with an average pedicle length of 6.9 cm and an average artery diameter of 1.4 mm. Recipient vessels utilized included the dorsal metatarsal artery, arcuate artery, medial and lateral tarsal arteries, and digital artery, with an average diameter of 1.5 mm. Conclusion: Mini free flap reconstruction is an effective solution for small DFUs, offering a reliable method for foot salvage. By utilizing advanced imaging techniques for precise vessel and flap selection, this approach ensures optimal flap survival and eventually improves patients’ quality of life by avoiding unnecessary amputations.