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World J Diabetes. Jun 15, 2026; 17(6): 118576
Published online Jun 15, 2026. doi: 10.4239/wjd.118576
Published online Jun 15, 2026. doi: 10.4239/wjd.118576
Improving intraoperative perfusion reliability in anterolateral thigh free flap reconstruction for diabetic foot ulcers
Peng-Yu Lu, Zhuang-Yu Hao, Guang-Wei Xing, Peng-Fei Zhang, Yan-Song Liu, Wen-Yang Li, Ming-Jie Xu, First Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Author contributions: Lu PY contributed to conceptualization, literature review, and writing the original draft; Hao ZY performed the formal analyses and contributed to methodology development and data curation; Xing GW contributed to the investigation, literature screening, and software-assisted data extraction/visualization; Zhang PF contributed to the methodology design, figure/table preparation, and review and editing; Liu YS contributed to the validation, critical revision for important intellectual content, and project administration/coordination; Li WY contributed to resources, supervision support, and critical review of the manuscript; Xu MJ supervised the study and was responsible for visualization oversight, manuscript final editing, and final approval of the version to be published; All authors participated in manuscript preparation and approved the final version of the manuscript.
AI contribution statement: AI-assisted tools, including ChatGPT/DeepL/Grammarly or similar language tools, were used only for language polishing, grammar correction, limited translation assistance, and improvement of readability during the preparation and revision of this manuscript. No portion of the main text of the manuscript, including the abstract, introduction, main body sections, discussion-related interpretation, and conclusion, was generated by AI. The conception of the manuscript, literature selection, evidence synthesis, clinical interpretation, intellectual content, and conclusions were independently completed by the authors. No AI tool was used for data analysis, study design, clinical reasoning, interpretation of results, or formulation of conclusions. All authors have carefully reviewed and verified the accuracy, integrity, and scientific validity of the manuscript and take full responsibility for its entire content. No images, figures, tables, or scientific illustrations in this manuscript were generated by AI.
Supported by the 2023 Henan Provincial Medical Science and Technology Research Program (Joint Co-Construction Project), No. LHGJ20230409.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Corresponding author: Ming-Jie Xu, MD, Professor, First Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, No. 3 Kangfuqian Street, Erqi District, Zheng
Received: January 6, 2026
Revised: February 22, 2026
Accepted: April 15, 2026
Published online: June 15, 2026
Processing time: 156 Days and 22.4 Hours
Revised: February 22, 2026
Accepted: April 15, 2026
Published online: June 15, 2026
Processing time: 156 Days and 22.4 Hours
Core Tip
Core Tip: Intraoperative perfusion remains a key failure point in anterolateral thigh free-flap reconstruction for diabetic foot ulcers. Perfusion is not determined by microsurgical technique alone but reflects a systemic-regional-microcirculatory continuum, often confounded by diabetes-related macrovascular calcification and microvascular dysfunction. We emphasize standardizing indocyanine green fluorescence angiography and shifting from single intensity snapshots to time-intensity kinetics, interpreted alongside toe pressure/toe-brachial index, skin perfusion pressure, and transcutaneous oxygen tension. An actionable perioperative optimization bundle (glycemia, anemia, oxygen delivery, nutrition, monitoring) may improve flap reliability and limb salvage.