Answer:
Two common misconceptions regarding diabetic patients have fostered a hopeless attitude on the part of the physician. The first misconception is that the foot problems are due to “small-vessel disease.” This prevailing view dates back to the work of Goldenberg in 1959 in which amputation specimens from diabetic and nondiabetic patients were studied retrospectively by light microscopy. Material positive on PAS staining was observed in the arterioles and interpreted as a specific arteriolosclerosis of diabetes. A subsequent prospective study with specimens subjected to blind histologic interpretation failed to demonstrate arteriolar occlusive disease on the basis of positive PAS staining. The second misconception is that there is endothelial proliferation in the small vessels of diabetic patients. Prospective studies have failed to show an increased incidence of intimal hyperplasia in the small vessels of diabetic patient. Preoperative evaluation of the vascular status is paramount to the successful treatment of the wound. Wounds are debrided at the time of the vascular inflow procedure followed by definitive wound coverage in 5-7 days. The delay ensures that anastomotic failure would not jeopardize flap viability and allow for preoperative bacteriologic control of the wounds. Studies have shown that limb salvage can be effected with free tissue transfer in properly selected patients.