Dalla Paola L, Baldazzi G, Gabellini T, Cosacco A M, Massi I, Carone A, Brocchi A, Mucignat M, Alnaser A
Diabetic Foot Department, Maria Cecilia Hospital GVM Care & Research, Ravenna, Italy.
Vascular Surgery Institute, Ferrara University School of Medicine, Ferrara, Italy.
Int J Low Extrem Wounds. 2025 Mar;24(1):170-176. doi: 10.1177/15347346231185403. Epub 2023 Jul 11.
After surgical treatment of Charcot neuro-osteoarthropathy (CNO) complicated by plantar ulcer and midtarsal osteomyelitis, offloading is mandatory to protect the surgical site. Total contact casting is, to date, the standard-of-care to offload the foot during the postoperative period. We have compared the application of external circular fixator, to the standard of care, with regard to surgical wound healing and time to healing. During the time period from January 2020 to December 2021, 71 consecutive patients admitted to our unit with diabetes and CNO complicated by plantar ulceration and midtarsal osteomyelitis were enrolled in our study. All patients were classified as stage 2, according to the Frykberg & Sanders classification. Wifi wound stage was W2 I0 FI2 in 43 of 71 patients (60.6%) and W2 I2 FI2 in 28 of 71 patients (39.4%). In cases where critical limb ischemia occurred, we performed an endovascular procedure to obtain patency in at least one of the tibial arteries. Localization of osteomyelitis was carried out with magnetic resonance imaging studies, and the degree of deformity was assessed using plain X-ray or computed tomography. A localized ostectomy through the ulceration was carried out with a fasciocutaneous flap to cover the surgical site. In 36 patients, an external circular fixator was applied intraoperatively (exfix+ group); the remaining 35 patients received fiberglass cast in the postoperative period (exfix- group). Complete healing of the surgical site was achieved in 36 of 36 patients in the exfix+ arm and in 22 of 35 in the exfix- arm ( < .02). Time to healing was 68 ± 28 days in exfix+ and 102 ± 88 days in exfix- ( = .05). Circular external frames should be considered as an effective offloading device that enhances the healing rate and reduces time to healing after surgical treatment of midfoot osteomyelitis in subjects affected by CNO.
在对合并足底溃疡和中跗骨骨髓炎的夏科氏神经骨关节病（CNO）进行手术治疗后，必须进行减负以保护手术部位。迄今为止，全接触石膏固定是术后足部减负的标准治疗方法。我们比较了外部环形固定器与标准治疗方法在手术伤口愈合及愈合时间方面的应用情况。在2020年1月至2021年12月期间，我们纳入了71例连续入住我院的糖尿病合并CNO且伴有足底溃疡和中跗骨骨髓炎的患者。根据Frykberg & Sanders分类，所有患者均被归类为2期。71例患者中，43例（60.6%）的伤口分期为W2 I0 FI2，28例（39.4%）为W2 I2 FI2。在发生严重肢体缺血的病例中，我们进行了血管内手术以使至少一条胫动脉通畅。通过磁共振成像研究确定骨髓炎的位置，并使用X线平片或计算机断层扫描评估畸形程度。通过溃疡进行局部骨切除术，并采用筋膜皮瓣覆盖手术部位。36例患者术中应用了外部环形固定器（外固定器+组）；其余35例患者术后接受玻璃纤维石膏固定（外固定器-组）。外固定器+组的36例患者中36例手术部位完全愈合，外固定器-组的35例患者中22例完全愈合（<0.0）。外固定器+组的愈合时间为68±28天，外固定器-组为102±88天（=0.05）。对于受CNO影响的患者，在中足骨髓炎手术治疗后，环形外固定架应被视为一种有效的减负装置，可提高愈合率并缩短愈合时间。
