Internal Offloading or Surgical Offloading Adjuvant Techniques in the Reconstruction of Diabetic Plantar First Metatarsal Head Ulcer For Lasting Results
Introduction Management of diabetic foot ulcers (DFUs) is subverted by recurrences. The main cause for the recurrence of DFUs is the failure to recognize and address all the faulty biomechanics precipitating and perpetuating the ulcer. So, we have devised a protocol for treating the diabetic plantar...
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2022-12-01
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| Series: | Indian Journal of Plastic Surgery |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1756135 |
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| author | Thalaivirithan Margabandu Balakrishnan Srividya Madhurbootheswaran Vanya Butcha Anjana Elangovan J. Jaganmohan |
| author_facet | Thalaivirithan Margabandu Balakrishnan Srividya Madhurbootheswaran Vanya Butcha Anjana Elangovan J. Jaganmohan |
| author_sort | Thalaivirithan Margabandu Balakrishnan |
| collection | DOAJ |
| description | Introduction Management of diabetic foot ulcers (DFUs) is subverted by recurrences. The main cause for the recurrence of DFUs is the failure to recognize and address all the faulty biomechanics precipitating and perpetuating the ulcer. So, we have devised a protocol for treating the diabetic plantar first metatarsal head ulcer (DPFMHUs) incorporating structured internal offloading procedures in conjunction with reconstruction.
Aim The aim of this study was to evaluate our protocol in the management of DPFMHUs.
Materials and Methods Fifty-one patients (31 males and 20 females) with DPFMHUs were managed with our protocol in this prospective cohort study conducted from March 2015 to March 2020. All the faulty biomechanics were addressed by tailored internal offloading procedure as per the protocol.
Results All patients were followed up for an average period of 23.7 months. Early complications were in the form of wound infection (3 patients, 5.9%) and seroma/hematoma (2 patients, 3.9%). Late complication in the form of recurrence was seen only in one patient (1.9%); rest of the patients had no recurrence (98%). Transfer lesions were noted in six patients (11.8%).
Conclusion Our tailored protocol, which addresses all the faulty biomechanics associated with the DPFMHU, may be very helpful in preventing the recurrence and to give lasting results. It is imperative to design a tailored internal/surgical offloading procedure for all deforming forces that are responsible for precipitation and perpetuation of DPFMHUs, in addition to like tissue reconstruction. |
| format | Article |
| id | doaj-art-3473be7c311444d3a005d83a0fc5d6ad |
| institution | OA Journals |
| issn | 0970-0358 1998-376X |
| language | English |
| publishDate | 2022-12-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Indian Journal of Plastic Surgery |
| spelling | doaj-art-3473be7c311444d3a005d83a0fc5d6ad2025-08-20T02:01:45ZengThieme Medical and Scientific Publishers Pvt. Ltd.Indian Journal of Plastic Surgery0970-03581998-376X2022-12-01550433935010.1055/s-0042-1756135Internal Offloading or Surgical Offloading Adjuvant Techniques in the Reconstruction of Diabetic Plantar First Metatarsal Head Ulcer For Lasting ResultsThalaivirithan Margabandu Balakrishnan0Srividya Madhurbootheswaran1Vanya Butcha2Anjana Elangovan3J. Jaganmohan4Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, IndiaDepartment of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, IndiaDepartment of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, IndiaDepartment of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, IndiaDepartment of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, IndiaIntroduction Management of diabetic foot ulcers (DFUs) is subverted by recurrences. The main cause for the recurrence of DFUs is the failure to recognize and address all the faulty biomechanics precipitating and perpetuating the ulcer. So, we have devised a protocol for treating the diabetic plantar first metatarsal head ulcer (DPFMHUs) incorporating structured internal offloading procedures in conjunction with reconstruction. Aim The aim of this study was to evaluate our protocol in the management of DPFMHUs. Materials and Methods Fifty-one patients (31 males and 20 females) with DPFMHUs were managed with our protocol in this prospective cohort study conducted from March 2015 to March 2020. All the faulty biomechanics were addressed by tailored internal offloading procedure as per the protocol. Results All patients were followed up for an average period of 23.7 months. Early complications were in the form of wound infection (3 patients, 5.9%) and seroma/hematoma (2 patients, 3.9%). Late complication in the form of recurrence was seen only in one patient (1.9%); rest of the patients had no recurrence (98%). Transfer lesions were noted in six patients (11.8%). Conclusion Our tailored protocol, which addresses all the faulty biomechanics associated with the DPFMHU, may be very helpful in preventing the recurrence and to give lasting results. It is imperative to design a tailored internal/surgical offloading procedure for all deforming forces that are responsible for precipitation and perpetuation of DPFMHUs, in addition to like tissue reconstruction.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1756135diabetic footdiabetic foot ulcersplantar first metatarsal head ulcersinternal or surgical offloading |
| spellingShingle | Thalaivirithan Margabandu Balakrishnan Srividya Madhurbootheswaran Vanya Butcha Anjana Elangovan J. Jaganmohan Internal Offloading or Surgical Offloading Adjuvant Techniques in the Reconstruction of Diabetic Plantar First Metatarsal Head Ulcer For Lasting Results Indian Journal of Plastic Surgery diabetic foot diabetic foot ulcers plantar first metatarsal head ulcers internal or surgical offloading |
| title | Internal Offloading or Surgical Offloading Adjuvant Techniques in the Reconstruction of Diabetic Plantar First Metatarsal Head Ulcer For Lasting Results |
| title_full | Internal Offloading or Surgical Offloading Adjuvant Techniques in the Reconstruction of Diabetic Plantar First Metatarsal Head Ulcer For Lasting Results |
| title_fullStr | Internal Offloading or Surgical Offloading Adjuvant Techniques in the Reconstruction of Diabetic Plantar First Metatarsal Head Ulcer For Lasting Results |
| title_full_unstemmed | Internal Offloading or Surgical Offloading Adjuvant Techniques in the Reconstruction of Diabetic Plantar First Metatarsal Head Ulcer For Lasting Results |
| title_short | Internal Offloading or Surgical Offloading Adjuvant Techniques in the Reconstruction of Diabetic Plantar First Metatarsal Head Ulcer For Lasting Results |
| title_sort | internal offloading or surgical offloading adjuvant techniques in the reconstruction of diabetic plantar first metatarsal head ulcer for lasting results |
| topic | diabetic foot diabetic foot ulcers plantar first metatarsal head ulcers internal or surgical offloading |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1756135 |
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