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Reconstructive Charcot surgery

Discussion in 'Diabetic Foot & Wound Management' started by pahomovigor, Feb 2, 2007.

  1. pahomovigor

    pahomovigor Member


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    Dear collegues! Could I remove little (1x0,5 cm)dry plantar ulcer and close wound with sutures during reconstructive surgery of cold Sharcot foot (Shopart arthrodesis) or I have to wait complete ulcer healing?
     
  2. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Re: reconsrtructive Sharcot surgery/

    pahomovigor

    You could excise and close the ulcer, but I would avoid doing an arthrodesis until it has healed.

    Why not heal the ulcer first in a total contact cast or removable CAM walker, then do the arthrodesis later to lessen risk of infection?

    Or how about removal of just the underlying exostosis and excision of the ulcer if the foot is relatively stable, before attempting arthrodesis?

    LL
     
  3. Admin2

    Admin2 Administrator Staff Member

  4. By not waiting for the ulcer to heal completely you probably increase the risk of infection at your operative site. However, if the ulcer is fairly clean and superficial, I am sure many surgeons would go ahead and close the ulcer primarily during the Charcot reconstructive surgery. Surgeon's choice.
     
  5. Carol Mounier

    Carol Mounier Welcome New Poster

    It is quite possible that correcting the charcot foot will allow the ulcer to heal faster .
     
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  10. drsarbes

    drsarbes Well-Known Member

    What "charcot reconstructive" procedure are you planning?
    Where is the ulcer relative to the bony pathology?

    I would agree with LL and Dr. Kirby that it may be of value to the outcome of your reconstruction to go ahead and heal the ulcer first. The only point I might add is that if the ulcer is caused by, say, a subluxed Calcaneal Cuboid or other area that you are planning on fusing, then it may make more sense to correlate the fusion with a closure of the small ulcer (or just pack it if you are going apply a NWB cast anyway).

    Steve
     
  11. Gibby

    Gibby Active Member

    It depends on variables such as (1) where ulcer is in relation to reconstruction, (2) what type of "reconstruction" is proposed- an arthrodesis, I assume, (3) post-operative plans (immobilization)
     
  12. abotammam11

    abotammam11 Welcome New Poster

    it is much better to leave the ulcer unclosed but after good deridment and removal of all callus areas followed by total contact cast ,, we have much data regarding this work in correcting the charcot's foot.
    thank you very much

    abdulhakim Al-tamimi
    General surgeon, diabetic foot interest
    university of Aden , Yemen
     
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