Nagasaki Kazuhito, Kikuchi Kyota, Tomita Masuomi, Hisamichi Katsuya, Izumi Yuko
Department of Vascular Surgery, Lower Limb Vascular and Wound Center, Shimokitazawa Hospital, Tokyo 155-0031, Japan.
Department of Orthopedics, Lower Limb and Foot Diseases Comprehensive Center, Shimokitazawa Hospital, Tokyo 155-0031, Japan.
J Clin Med. 2025 Jan 21;14(3):646. doi: 10.3390/jcm14030646.
Diabetic ischemic ulcers with toe deformities are challenging to manage due to combined ischemia, infection, and mechanical stress. This case report highlights the successful treatment of a complex diabetic ischemic ulcer using a multidisciplinary approach that included revascularization and surgical offloading. A 70-year-old male with type 2 diabetes mellitus presented with non-healing ulcers on the right third toe. The ulcers, located at the dorsal PIP joint and plantar MTP joint, were attributed to ischemia, infection, and progressive toe deformity. Angiography revealed significant arterial stenosis, which was treated with percutaneous transluminal angioplasty (PTA) to restore in-line flow and improve skin perfusion pressure. Surgical offloading included PIP resection arthroplasty and metatarsal shortening osteotomy. Postoperative management ensured complete ulcer healing, and no recurrence was observed during the three-year follow-up. This case underscores the importance of combining revascularization to improve perfusion and surgical offloading to alleviate mechanical stress. Key factors for success included the restoration of in-line flow, achieving sufficient skin perfusion pressure, and reducing plantar pressure. Multidisciplinary collaboration among vascular surgeons, orthopedists, and wound care specialists played a critical role in achieving excellent long-term outcomes. Revascularization followed by surgical offloading provided effective treatment for a diabetic ischemic ulcer with toe deformity. This multidisciplinary approach demonstrates the necessity of individualized strategies to manage complex diabetic foot cases and prevent recurrence.
伴有趾畸形的糖尿病缺血性溃疡因合并缺血、感染和机械应力而难以处理。本病例报告强调了采用包括血运重建和手术减负在内的多学科方法成功治疗复杂的糖尿病缺血性溃疡。一名70岁2型糖尿病男性患者，右足第三趾出现不愈合溃疡。这些溃疡位于近端指间关节背侧和跖趾关节跖侧，病因是缺血、感染和逐渐加重的趾畸形。血管造影显示严重动脉狭窄，通过经皮腔内血管成形术（PTA）进行治疗以恢复直线血流并改善皮肤灌注压。手术减负包括近端指间关节切除关节成形术和跖骨缩短截骨术。术后管理确保溃疡完全愈合，在三年随访期间未观察到复发。本病例强调了联合血运重建以改善灌注和手术减负以减轻机械应力的重要性。成功的关键因素包括恢复直线血流、达到足够的皮肤灌注压以及降低足底压力。血管外科医生、骨科医生和伤口护理专家之间的多学科协作在取得优异的长期结果中发挥了关键作用。血运重建后进行手术减负为伴有趾畸形的糖尿病缺血性溃疡提供了有效的治疗方法。这种多学科方法证明了采用个体化策略处理复杂糖尿病足病例并预防复发的必要性。
