Publication Name	World Journal of Diabetes
Manuscript ID	118576
Country	China

Category	Orthopedics
Manuscript Type	Opinion Review
Article Title	Improving intraoperative perfusion reliability in anterolateral thigh free flap reconstruction for diabetic foot ulcers
Manuscript Source	Unsolicited Manuscript
All Author List	Peng-Yu Lu, Zhuang-Yu Hao, Guang-Wei Xing, Peng-Fei Zhang, Yan-Song Liu, Wen-Yang Li and Ming-Jie Xu
Funding Agency and Grant Number	Funding Agency Grant Number the 2023 Henan Provincial Medical Science and Technology Research Program (Joint Co-construction Project) LHGJ20230409
Corresponding Author	Ming-Jie Xu, Head, MD, Professor, First Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, No.3 Kangfuqian Street, Erqi District, Zhengzhou 450052, Henan Province, China. 65727257@qq.com
Key Words	Anterolateral thigh flap; Diabetic foot ulcer; Indocyanine green angiography; Limb salvage; Nutritional status; Perfusion assessment; Systemic optimization; Tissue oxygenation
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.
Citation	Lu PY, Hao ZY, Xing GW, Zhang PF, Liu YS, Li WY, Xu MJ. Improving intraoperative perfusion reliability in anterolateral thigh free flap reconstruction for diabetic foot ulcers. World J Diabetes 2026; In press

Received	2026-01-06 05:40
Peer-Review Started	2026-01-06 07:06
First Decision by Editorial Office Director	2026-02-10 09:19
Return for Revision	2026-02-10 09:19
Revised	2026-02-22 11:19
Publication Fee Transferred
Second Decision by Editor	2026-04-15 02:39
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-04-15 10:16
Articles in Press	2026-04-15 10:16
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	1948-9358 (online)
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