Four-stage regimen for operative treatment of diabetic foot ulcer with deformity

NewsBot · Oct 26, 2012

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Four-stage regimen for operative treatment of diabetic foot ulcer with deformity - Results of 300 patients.
Richter M, Zech S.
Foot Ankle Surg. 2012 Dec;18(4):247-54.

BACKGROUND:
An operative four-stage regimen (stage 1, debridement; stage 2, closure; stage 3, unloading; stage 4, correction) for operative treatment of diabetic foot ulcer with deformity, and first clinical results are introduced.

METHODS AND RESULTS:
335 patients entered stage 1 between 01/09/2006 and 31/08/2010. Stage 1: In 189 cases (56%), one debridement resulted in sterile postoperative specimens. Stage 2: 210 cases (63%) sustained secondary closure, 97 (29%) local shifted skin graft, and 20 (6%) functional amputation. Stage 3: 304 (90%) finished stage 3, 14 (4%) presented with recurrent ulcer. Stage 4: In 185 cases (55%), correction arthrodeses were performed successfully. Follow-up: 300 (90%) completed follow-up at 26months on average (12-48months). Recurrent ulcer was registered in 46 (15%). Overall amputation rate was 14%, the majority at digital or midfoot level. Four cases (1%) required a below-knee amputation.

CONCLUSIONS:
The management of diabetic foot ulcer combined with deformity with the introduced regimen showed low major amputation rate and low recurrent ulcer rate compared with the literature.
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