Martin J D, Delbridge L, Reeve T S, Clagett G P
Department of Surgery, University of Texas Southwestern Medical Center, Dallas 75235-9031.
J Vasc Surg. 1990 Sep;12(3):264-8.
Forty patients with diabetes mellitus and severe mal perforans underwent dorsal excision of the involved metatarsal head with primary closure of the plantar ulcer. Patients were screened before operation with noninvasive studies documenting pulse examination, ankle pressure index, and toe blood pressures. Fifteen of 40 patients (38%) had no palpable pedal pulses. Three patients had vascular reconstruction before metatarsal head resection. Mean toe pressure of the entire group was 135 +/- 35 mm Hg (range, 60 to 190), with six patients having a pressure less than 100 mm Hg. All patients had primary healing of the plantar wound and secondary healing of the dorsal incision with no amputations or readmissions for forefoot sepsis in the mean follow-up of 38.5 months (range, 2 to 54 months). In seven patients with recurrent ulcers, no relationship was found between measured indexes of forefoot perfusion and recurrence. However, all patients with recurrence were noncompliant in returning for follow-up orthotic care. This technique provides a means to ensure rapid healing of severe mal perforans while decreasing hospitalization, wound care, and periods of immobilization and is applicable in diabetic patients with arterial insufficiency and toe pressure of at least 60 mm Hg.
40例患有糖尿病和严重足底溃疡的患者接受了受累跖骨头的背侧切除，并对足底溃疡进行一期缝合。术前对患者进行了无创检查，记录脉搏检查、踝压指数和趾血压。40例患者中有15例（38%）足部脉搏触诊不清。3例患者在跖骨头切除术前进行了血管重建。整个组的平均趾压为135±35mmHg（范围为60至190），6例患者的压力低于100mmHg。所有患者足底伤口均一期愈合，背侧切口二期愈合，平均随访38.5个月（范围为2至54个月），无截肢或因前足脓毒症再次入院的情况。在7例复发性溃疡患者中，未发现前足灌注测量指标与复发之间存在关联。然而，所有复发患者均未按时返回接受后续的矫形护理。该技术提供了一种确保严重足底溃疡快速愈合的方法，同时减少了住院时间、伤口护理以及固定时间，适用于动脉供血不足且趾压至少为60mmHg的糖尿病患者。
