Ngiam Hian Kim Erica, Png Wenxian, Cher Eric Wei Liang, Ch'ng Jack Kian, Wong Allen Wei Jiat, Kok Yee Onn, Feng Jiajun
From the Department of Plastic, Reconstructive and Aesthetic Surgery, Sengkang General Hospital, Singapore.
Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore.
Plast Reconstr Surg Glob Open. 2025 Apr 21;13(4):e6719. doi: 10.1097/GOX.0000000000006719. eCollection 2025 Apr.
Diabetic foot ulcers are challenging to manage due to the multifactorial nature of the disease, with diabetic neuropathy being a primary contributing factor. Tarsal tunnel release has shown promise in restoring sensation, reducing ulcer recurrence through improved sensation, and enhancing microcirculation to promote ulcer healing. However, existing open and endoscopic techniques have notable limitations. This study introduces a novel minimally invasive tarsal tunnel release technique designed to address these shortcomings.
A retrospective cohort study was conducted at Sengkang General Hospital, a tertiary care center. The control group comprised 22 consecutive patients who underwent open tarsal tunnel release, whereas the treatment group included 34 consecutive patients treated with the novel minimally invasive approach. All patients were followed up for a minimum of 3 months.
Both groups demonstrated comparable efficacy in improving sensation (100% versus 95.5%) and 2-point discrimination (88.2% versus 86.4%; = 0.19, = 0.83, respectively). However, the treatment group exhibited significantly shorter wound lengths (2.3 ± 0.26 versus 5.8 ± 0.72 cm; < 0.0001) and a faster wound healing duration (15 ± 5 versus 24 ± 17 d; = 0.0052). Additionally, the treatment group experienced no major wound complications compared with a 13.6% complication rate in the control group ( = 0.029).
This minimally invasive novel technique demonstrates similar efficacy in improving sensation while addressing the limitations of existing open and endoscopic methods. It offers significant advantages in terms of reduced wound size, faster healing, and lower complication rates.
糖尿病足溃疡因疾病的多因素性质而难以管理，糖尿病神经病变是主要促成因素。跗管松解术在恢复感觉、通过改善感觉减少溃疡复发以及增强微循环以促进溃疡愈合方面已显示出前景。然而，现有的开放和内镜技术存在明显局限性。本研究引入了一种新型微创跗管松解技术以解决这些缺点。
在三级护理中心樟宜综合医院进行了一项回顾性队列研究。对照组包括22例连续接受开放跗管松解术的患者，而治疗组包括34例连续接受新型微创方法治疗的患者。所有患者均随访至少3个月。
两组在改善感觉（100%对95.5%）和两点辨别觉（88.2%对86.4%；分别为P = 0.19，P = 0.83）方面显示出相当的疗效。然而，治疗组的伤口长度明显更短（2.3±0.26对5.8±0.72 cm；P < 0.0001），伤口愈合持续时间更快（15±5对24±17天；P = 0.0052）。此外，治疗组未发生重大伤口并发症，而对照组的并发症发生率为13.6%（P = 0.029）。
这种新型微创技术在改善感觉方面显示出相似的疗效，同时解决了现有开放和内镜方法的局限性。它在减小伤口大小、加快愈合和降低并发症发生率方面具有显著优势。
