Vanlerberghe B, Devemy F, Duhamel A, Guerreschi P, Torabi D
Service de chirurgie plastique, reconstructrice et esthétique, hôpital Roger Salengro, rue Émile-Laine, 59037 Lille, France.
Service de médecine, hôpital Dr Shaffner, 99, route de La Bassée, 62300 Lens, France.
Ann Chir Plast Esthet. 2014 Jun;59(3):161-9. doi: 10.1016/j.anplas.2013.07.008. Epub 2013 Aug 22.
The plantar neuropathic ulcer is a classical and frequent complication of a pathology recognized as pandemic by the WHO: diabetes. Even if frequently encountered during medical practice, the neuropathic ulcer remains poorly understood in its pathophysiology. Its treatment is usually long and disappointing, resulting too often in an amputation. Paradoxically, medical literature is particularly scarce on the subject of surgical approaches to the plantar neuropathic ulcer. Beyond the cases of vascular lesions requiring above all a technique of revascularization, we have tested out an original approach enabling the surgical treatment of an overt neuropathic ulcer. Our purpose was to correct the architecture of the foot for a superior distribution of foot support points. We performed subtraction osteotomies ahead of the neuropathic ulcer in order to redress the deformed bone axis. Standing with full weight on the foot is prescribed from the following day of the intervention in almost all cases.
We have evaluated the effectiveness of this innovative conservative surgical treatment on neuropathic ulcers of metatarsal heads by comparing it with the usual medical treatment. Two groups of patients have thus been analysed for this retrospective comparative study in order to determinate whether the use of this surgical technique benefits the patient. The studied criteria were healing time, recurrence rate, amputation rate and overall failure rate of the treatment, represented by the occurrence of the event "recurrence or amputation".
All the differences found were in favour of the surgical technique with, in particular, significant differences in healing time, amputation rate and occurrence rate of the event "recurrence or amputation". The difference in recurrence rate was also clearly in favour of the surgery group, but it was not significant.
The conservative surgical treatment by proximal osteotomy is therefore an innovative technique enabling a significant improvement in healing time and treatment after-effects of neuropathic ulcers in non-arteritis diabetic patients.
