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CC BY-NC-ND 4.0 · Indian J Plast Surg 2022; 55(04): 339-350
DOI: 10.1055/s-0042-1756135
Original Article

Internal Offloading or Surgical Offloading Adjuvant Techniques in the Reconstruction of Diabetic Plantar First Metatarsal Head Ulcer For Lasting Results

Thalaivirithan Margabandu Balakrishnan 
1   Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India
,
Srividya Madhurbootheswaran
1   Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India
,
Vanya Butcha
1   Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India
,
Anjana Elangovan
1   Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India
,
J. Jaganmohan
1   Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India
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Abstract

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.

Keywords

diabetic foot - diabetic foot ulcers - plantar first metatarsal head ulcers - internal or surgical offloading


Publication History

Article published online:
31 October 2022

© 2022. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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