Limb salvage using microvascular reconstructions for secondary regional vascular insufficiency in the neuro ischemic diabetic foot; is it making impact? Thalaivirithan Margabandu Balakrishnan, Illayakumar Pramasivam, Krishnakumar Thirunavukarasu, Jaganmohan Janardhanan, Sritharan Narayanan Indian Journal of Vascular and Endovascular Surgery 2019 6(2):65-73 Introduction: Secondary regional vascular insufficiency (RVI) is a pathophysiological state that occurs most commonly following the successfully involved perforosome-directed distal revascularization (IPDDR). This IPDDR renders bounding pulse in the vicinity of diabetic foot ulcer, which shows no signs of early granulation (the sign of healing potential) for variable time. This is the main cause for delaying the definitive reconstruction in the successfully revascularized diabetic foot. Aim: The aim of this study is to evaluate the effectiveness of microvascular and nonmicrovascular reconstructions (NMVRs) in the treatment of secondary RVI of the neuroischemic diabetic foot following successful IPDDR. Endpoints assessed in this study were as follows: (1) Time taken to render a stable and shoe able foot or foot residuum following successful revascularization of the neuroischemic diabetic foot. (2) Time interval between IPDDR and definitive reconstruction in both groups. (3) Rate of complications including recurrence of foot ulcers and failures of reconstruction in each group. Patients and Methods: From 2014 to 2017, 128 neuroischemic diabetic foot patients (a multicenter study) after successful IPDDR for their critical limb ischemia subsequently underwent various types of reconstructions. All had a variable period of secondary RVI following successful revascularization. A retrospective study was conducted by dividing them into two groups – MVR group with 69 patients and NMVR group with 59 patients. The interval between the IPDDR and definitive reconstructions in each group was called the “latent period.” All were followed up for an average period of 30 months. The standard postoperative care and offloading techniques were followed in both groups. Results: The average time taken for obtaining shoeable and stable foot or its residuum in the MVR group was 55.5 days and NMVR group was 76.5 days. By statistical analysis, the MVR group had lesser latency period (P = 0.042), lesser ulcer recurrences (P = 0.044), and lesser flap and reconstruction failures leading to amputation (P = 0.0345). Conclusion: The MVR by bringing tissue from above or at the level of hip area produces sound and early healing of secondary RVI with higher limb salvage rate following the successful revascularization of neuroischemic diabetic foot.