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

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.