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[Treatment of plantar, neuropathic and metatarsal ulcers by minimally invasive metatarsal osteotomy]. / Behandlung von plantaren, neuropathischen und metatarsalen Ulzera mittels distaler minimalinvasiver metatarsaler Osteotomie.
Mehlhorn, Alexander T; Harrasser, Norbert; Walther, Markus.
Afiliação
  • Mehlhorn AT; Zentrum für Fuß- und Sprunggelenkschirurgie, Schönklinik München-Harlaching, Harlachingerstraße 51, 81547, München, Deutschland. amehlhorn@schoen-klinik.de.
  • Harrasser N; Klinik für Orthopädie und Unfallchirurgie, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland. amehlhorn@schoen-klinik.de.
  • Walther M; Zentrum für Fuß- und Sprunggelenkschirurgie, Schönklinik München-Harlaching, Harlachingerstraße 51, 81547, München, Deutschland.
Orthopade ; 49(7): 625-631, 2020 Jul.
Article em De | MEDLINE | ID: mdl-31863150
BACKGROUND: The chronic-mechanical plantar ulcer in diabetic-neuropathic foot syndrome is the starting point for severe infections of the foot and amputations. Frequent predilection sites are the metatarsal heads (MTH); in the context of neuropathy increased plantar peak pressure occurs and leads to an ulcer. GOAL: In this paper, we will examine whether minimally invasive pressure-reducing osteotomies, such as distal, minimally invasive metatarsal osteotomy (DMMO), can lead to the healing of metatarsal ulcers. Furthermore, the frequency of postoperative complications will be analyzed. METHOD: In a prospective study, n = 26 consecutive patients with plantar grade IA, IIA, and IIIA ulcers according to Wagner/Armstrong were included in the study under MTH 2, 3, 4 and 5 and with an unsuccessful conservative therapy >6 months. All patients received a DMMO of MT 2, 3, and 4, unless the ulcer was under MTH 5, then isolated DMMO MT 5 was performed. Clinical radiological check-ups took place over a follow-up interval of 26 ± 18 months (8-43 months). RESULTS: In all patients, the plantar ulcera healed after 5 ± 1 week, the recurrence rate was 8% and 3 patients had a transfer ulcer. Complications such as infection, pseudarthrosis or neuroosteoarthropathy did not occur. CONCLUSION: DMMO is an effective method for the treatment of recalcitrant ulcers under the metatarsal heads. The rate of a long-term cure is high; the complication rate is low; in ulcers under MTH 5, the DMMO should possibly be extended to the other metatarsal heads to reduce the risk of a transfer ulcer.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Osteotomia / Ossos do Metatarso / Úlcera do Pé / Pé Diabético / Procedimentos Cirúrgicos Minimamente Invasivos Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Humans Idioma: De Revista: Orthopade Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Osteotomia / Ossos do Metatarso / Úlcera do Pé / Pé Diabético / Procedimentos Cirúrgicos Minimamente Invasivos Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Humans Idioma: De Revista: Orthopade Ano de publicação: 2020 Tipo de documento: Article