Correspondence
Interdisciplinary collaboration is important in peripheral arterial disease
;
Kröger et al. described a welcome fall in the rate of major amputations in patients with peripheral arterial disease (PAD) and diabetes mellitus. Simultaneously they found that the rate of minor amputations has risen. The article is very detailed and carefully researched and includes the evaluation of data from 2005–2014.
In the article‘s discussion section, the authors point out that PAD of the limbs can be treated very effectively by using interventional vascular surgery (1). Emphasis is put on the interdisciplinary approach in this setting. We welcome and appreciate this approach very much indeed. However, as plastic and esthetic surgeons we miss the mention of microsurgical reconstruction using flaps to cover large defects on the lower limb in patients with diabetes and PAD (2). In our view, these constitute effective and safe options for treating defects with exposed functional structures to a sufficient and sustained extent. The interdisciplinary setting in particular makes it possible to form an anastomosis of free flaps to autologous venous bypass grafts, which at the same time improves perfusion (2, 3).
By routinely involving plastic surgeons, the options improve for covering defects on the lower extremity in a timely manner, which in turns leads to a fall in minor and major amputation rates and improves affected patients‘ quality of life.
DOI: 10.3238/arztebl.2017.0399c
Dr. med. Steffen Schirmer
Department für Plastische und Ästhetische Chirurgie
Helios Klinikum Berlin Buch
Steffen.Schirmer@helios-kliniken.de
Prof. Dr. med. Hisham Fansa, MBA
Gemeinschaftspraxis Prof. Heitmann & Prof. Fansa, München
Conflict of interest statement
The authors declare that no conflict of interest exists.
| 1. | Kröger K, Berg C, Santosa F, Malyar N, Reinecke H: Lower limb amputation in Germany—an analysis of data from the German Federal Statistical Office between 2005 and 2014. Dtsch Arztebl Int 2017; 114: 130–6 VOLLTEXT |
| 2. | Schirmer S, Ritter RG, Fansa H: Vascular surgery, microsurgery and supramicrosurgery for treatment of chroinic diabetic foot ulcers to prevent amputations. PloS One 2013; 8. |
| 3. | Daigeler A, Kneser U, Fansa H, Riester T, Uder M, Horch RE: Reconstruction of the vascular compromised lower extremity—report of the consensus workshop of the 35. meeting of the DAM (Deutschsprachige Gemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße) 2013 in Deidesheim. Handchir Mikrochir Plast Chir 2014; 46: 248–55 MEDLINE |
