Elhaddad Moamen, Carrillo-Kashani Alexander, Tavakalyan Karina, Massaband Behnam David
Foot and Ankle Surgery, Cedars-Sinai Medical Center, Los Angeles, USA.
Cureus. 2025 Mar 30;17(3):e81484. doi: 10.7759/cureus.81484. eCollection 2025 Mar.
Chronic plantar ulcers in Charcot neuropathic osteoarthropathy (CNO) present a significant challenge in limb salvage due to biomechanical instability, poor tissue quality, and high mechanical stress at weight-bearing sites. Traditional surgical techniques, such as exostectomy and tendo-Achilles lengthening (TAL), effectively redistribute plantar pressure but often fail to provide durable soft tissue coverage. This study describes the first documented use of a Dufourmentel rhomboid flap for reconstructing a chronic plantar midfoot ulcer in a 59-year-old female with CNO and poorly controlled diabetes. The patient presented with a non-healing ulcer over a prominent osseous deformity, complicated by advanced neuropathy and a rocker-bottom foot. Surgical intervention included TAL, exostectomy, and meticulous wound debridement, followed by primary closure using a Dufourmentel flap to achieve tension-free, durable coverage. Postoperatively, the patient was managed with strict immobilization using a total contact cast and transitioned to a Charcot Restraint Orthotic Walker (CROW) boot. Despite partial non-compliance with weight-bearing restrictions, the wound healed completely by six months, with no recurrence. This case highlights the Dufourmentel flap as an innovative and effective reconstructive option for complex plantar ulcers in CNO, offering enhanced soft tissue resilience and long-term stability. The integration of TAL, exostectomy, and biomechanically optimized wound closure provides a comprehensive approach to limb salvage in high-risk diabetic patients. Further research is warranted to evaluate the flap's long-term outcomes and broader applicability in Charcot foot reconstruction.
夏科氏神经病变性骨关节炎（CNO）中的慢性足底溃疡，由于生物力学不稳定、组织质量差以及负重部位机械应力高，在保肢方面带来了重大挑战。传统手术技术，如骨赘切除术和跟腱延长术（TAL），能有效重新分配足底压力，但往往无法提供持久的软组织覆盖。本研究描述了首次有文献记载的使用杜福尔芒泰尔菱形皮瓣，为一名患有CNO且糖尿病控制不佳的59岁女性重建慢性足底中足溃疡。患者在明显的骨性畸形处有一个不愈合的溃疡，并发严重神经病变和摇椅底足。手术干预包括跟腱延长术、骨赘切除术和细致的伤口清创，随后使用杜福尔芒泰尔皮瓣进行一期缝合，以实现无张力、持久的覆盖。术后，患者使用全接触石膏进行严格固定，并过渡到夏科氏约束矫形步行器（CROW）靴。尽管部分患者未遵守负重限制，但伤口在六个月时完全愈合，无复发。该病例突出了杜福尔芒泰尔皮瓣作为CNO中复杂足底溃疡的一种创新且有效的重建选择，具有增强的软组织弹性和长期稳定性。跟腱延长术、骨赘切除术和生物力学优化的伤口闭合相结合，为高危糖尿病患者的保肢提供了一种全面的方法。有必要进一步研究以评估该皮瓣的长期效果及其在夏科氏足重建中的更广泛适用性。
