Engels G, Stinus H, Hochlenert D, Klein A
Sektion Wundchirurgie, Klinik für Diabetologie und Endokrinologie, St. Vinzenz Hospital, Chirurgische Praxis am Bayenthalgürtel, Bayenthalgürtel 45, 50968, Köln, Deutschland.
Orthopaedicum Nordheim-Göttingen, Göttingen, Deutschland.
Oper Orthop Traumatol. 2016 Oct;28(5):323-34. doi: 10.1007/s00064-016-0453-9. Epub 2016 Jun 28.
Elimination of plantarization of the tip of the toe and torsion of digit 1 (D1) or D5 using percutaneous tenotomy of the flexor hallucis longus (FHL) - or the flexor digitorum longus (FDL) muscle.
Flexible, in some cases also fixated hyperflexion misalignment and torsion misalignment of the distal phalanx of the toe with plantarization of physiologically non-loaded bearing parts of the toes in patients with diabetic foot syndrome (neuropathy).
Critical limb ischemia.
Percutaneous tenotomy of the FHL or FDL tendons using the minimally invasive lancet technique without the use of a tourniquet while the tendon is flexed by causing hyperextension of the distal phalanx and simultaneous extension of the distal interphalangeal (DIP) or interphalangeal (IP) joints.
Immediate full weight-bearing mobilization in sufficiently wide protective footwear with customized cushioning or a diabetes-adapted foot bed, follow-up in initially frequent intervals (2-4 per week) in order to track the development of the transfer lesions. In the case of existing wounds, more frequent visits and relief of the wounds using a post-operative shoe are required. No thrombosis prevention with full weight-bearing is necessary.
In 138 patients with diabetic foot syndrome with polyneuropathy, of which 90 were men (65.2 %) and 48 were women (34.8 %) with a median age of 65.1 years, a total of 291 toe operations with tenotomy of the FHL- or FDL-tendon were performed. Patients were either acutely affected by apical toe lesions (92.1 %) or showed an increased risk of ulcer formation (7.9 %). The median time to closing of the wound was 13 days. It was longer with higher Wagner stages. Of the surgically treated toes 3.1 % were affected by nosocomial infections. At the 1‑year follow-up 92.4 % of the patients did not show pathological results of the operated toe. Recurrence of the DFS occurred mostly during the first 6 months postoperatively. In the first year postoperatively 68.1 % of the patients remained in remission. Of the toes with Wagner grade 0, 93.7 % were free of local recurrence during the entire monitoring period and 72.2 % of the operated toes with Wagner grade 3. Within the first 1.5-8.5 months 13 % of the patients were affected by transfer lesions.
通过经皮切断拇长屈肌（FHL）或趾长屈肌（FDL）来消除趾尖跖屈以及第1趾（D1）或第5趾（D5）的扭转。
糖尿病足综合征（神经病变）患者中，趾远节指骨存在灵活的、在某些情况下也有固定的过度屈曲畸形和扭转畸形，且趾的生理非负重部位出现跖屈。
严重肢体缺血。
采用微创柳叶刀技术经皮切断FHL或FDL肌腱，不使用止血带，通过使远节指骨过伸并同时伸展远侧指间关节（DIP）或指间关节（IP）来使肌腱处于屈曲状态。
立即穿着足够宽的带有定制缓冲垫或糖尿病适配鞋垫的防护鞋进行完全负重活动，最初定期（每周2 - 4次）随访以跟踪转移病灶的发展。对于存在伤口的情况，需要更频繁就诊并使用术后鞋减轻伤口压力。完全负重时无需预防血栓形成。
在138例患有糖尿病足综合征合并多发性神经病变的患者中，其中男性90例（65.2%），女性48例（34.8%），中位年龄65.1岁，共进行了291次切断FHL或FDL肌腱的趾部手术。患者要么急性受趾尖病变影响（92.1%），要么有溃疡形成风险增加（7.9%）。伤口愈合的中位时间为13天。Wagner分级越高，愈合时间越长。手术治疗的趾部中3.1%发生医院感染。在1年随访时，92.4%的患者手术趾未出现病理结果。糖尿病足综合征复发大多发生在术后前6个月。术后第1年，68.1%的患者病情缓解。Wagner 0级的趾部中，93.7%在整个监测期内无局部复发，Wagner 3级的手术趾中有72.2%无局部复发。在最初的1.5 - 8.5个月内，13%的患者出现转移病灶。
