Advertisement
-
1.
Perkins BA, Olaleye D, Bril V: Carpal tunnel syndrome in patients with diabetic polyneuropathy. Diabetes Care 25: 565, 2002.
-
2.
Arad Y, Fonseca V, Peters A, et al: Beyond the monofilament for the insensate diabetic foot: a systematic review of randomized trials to prevent the occurrence of plantar foot ulcers in patients with diabetes. Diabetes Care 34: 1041, 2011.
-
3.
Bus SA, Valk GD, van Deursen RW, et al: Specific guidelines on footwear and offloading. Diabetes Metab Res Rev 24 (suppl 1): S192, 2008.
-
4.
Lavery LA, Higgins KR, Lanctot DR, et al: Preventing diabetic foot ulcer recurrence in high-risk patients: use of temperature monitoring as a self-assessment tool. Diabetes Care 30: 14, 2007.
-
5.
Aszmann O, Tassler PL, Dellon A: Changing the natural history of diabetic neuropathy: incidence of ulcer/amputation in the contralateral limb of patients with a unilateral nerve decompression procedure. Ann Plast Surg 53: 517, 2004.
-
6.
Dellon AL, Muse VL, Nickerson DS, et al: Prevention of ulceration, amputation, and reduction of hospitalization: outcomes of a prospective multicenter trial of tibial neurolysis in patients with diabetic neuropathy. J Reconstr Microsurg 28: 241, 2012.
-
7.
Nickerson DS: Low recurrence rate of diabetic foot ulcer after nerve decompression. JAPMA 100: 111, 2010.
-
8.
Nickerson DS, Rader AJ: Low long term risk of foot ulcer recurrence after nerve decompression in a diabetes neuropathy cohort. JAPMA 103: 380, 2013.
-
9.
Dellon AL: The Dellon approach to neurolysis in the neuropathy patient with chronic nerve compression. Handchir Mikrochir Plast Chir 40: 1, 2008.
-
10.
Pecoraro RE, Reiber GE, Burgess EM: Pathways to diabetic limb amputation: basis for prevention. Diabetes Care 13: 513, 1990.
-
11.
Ducic I, Taylor NS, Dellon AL: Relationship between peripheral nerve decompression and gain of pedal sensibility and balance in patients with peripheral neuropathy. Ann Plast Surg 56: 145, 2006.
-
12.
Rosson GD, Larson AR, Williams EH, et al: Tibial nerve decompression in patients with tarsal tunnel syndrome: pressures in the tarsal, medial plantar, and lateral plantar tunnels. Plast Reconstr Surg 124: 1202, 2009.
-
13.
Zhang W, Zhong W, Wang M et al: Evaluation of the clinical efficacy of multiple lower-extremity nerve decompression in diabetic peripheral neuropathy. Br J Neurosurg. [Epub ahead of print], 2013.
Nerve Decompression After Diabetic Foot Ulceration May Protect Against Recurrence
A 3-Year Controlled, Prospective Analysis
Background
Nerve entrapment, common in diabetes, is considered an associated phenomenon without large consequence in the development of diabetes complications such as ulceration, infection, amputation, and early mortality. This prospective analysis, with controls, of the ulcer recurrence rate after operative nerve decompression (ND) offers an objective perspective on the possibility of frequent occult nerve entrapment in the diabetic foot complication cascade.
Methods
A multicenter cohort of 42 patients with diabetic sensorimotor polyneuropathy, failed pharmacologic pain control, palpable pulses, and at least one positive Tinel's nerve percussion sign was treated with unilateral multiple lower-leg external neurolyses for the indication of pain. All of the patients had healed at least one previous ipsilateral plantar diabetic foot ulceration (DFU). This group was retrospectively evaluated a minimum of 12 months after operative ND and again 3 years later. The recurrence risk of ipsilateral DFU in that period was prospectively analyzed and compared with new ulcer occurrence in the contralateral intact, nonoperated control legs.
Results
Operated legs developed two ulcer recurrences (4.8%), and nine contralateral control legs developed ulcers (21.4%), requiring three amputations. Ulcer risk is 1.6% per patient per year in ND legs and 7% in nonoperated control legs (P = .048).
Conclusions
Adding operative ND at lower-leg fibro-osseous tunnels to standard postulcer treatment resulted in a significantly diminished rate of subsequent DFU in neuropathic high-risk feet. This is prospective, objective evidence that ND can provide valuable ongoing protection from DFU recurrence, even years after primary ulcer healing.
