Basic surgical principles applied when caring for neuropathic limbs can result in the maintenance or restoration of a useful ulcer-free limb. It is possible to help many patients with neuropathy to become ulcer-free and to remain ulcer-free and mobile, with surgical procedures. Recommended methods of management are briefly outlined. These include the débridement of the osteomyelitic, metatarsal head in order to save the adjacent toe, removal of bony irregularities that predispose to ulceration, and the use of wedge osteotomies and arthrodeses to improve the functional shape of the affected foot. The emphasis is on the removal of high pressure points from the weight-bearing surface and to increase the total area available for weight-bearing. Adequate rest and protection are essential, and include the use of splints or total contact plaster casts in all cases of ulceration of weight-bearing surfaces. All patients with reduced sensory perception should learn daily self-examination and care to reduce the chances of recurrent ulceration. Healing after surgical reconstruction will occur, and the healed tissues, if adequately cared for, will maintain their integrity for years.
BT - Annals of the Royal College of Surgeons of England C1 - http://www.ncbi.nlm.nih.gov/pubmed/2549839?dopt=Abstract DA - 1989 Jul IS - 4 J2 - Ann R Coll Surg Engl LA - eng N2 -Basic surgical principles applied when caring for neuropathic limbs can result in the maintenance or restoration of a useful ulcer-free limb. It is possible to help many patients with neuropathy to become ulcer-free and to remain ulcer-free and mobile, with surgical procedures. Recommended methods of management are briefly outlined. These include the débridement of the osteomyelitic, metatarsal head in order to save the adjacent toe, removal of bony irregularities that predispose to ulceration, and the use of wedge osteotomies and arthrodeses to improve the functional shape of the affected foot. The emphasis is on the removal of high pressure points from the weight-bearing surface and to increase the total area available for weight-bearing. Adequate rest and protection are essential, and include the use of splints or total contact plaster casts in all cases of ulceration of weight-bearing surfaces. All patients with reduced sensory perception should learn daily self-examination and care to reduce the chances of recurrent ulceration. Healing after surgical reconstruction will occur, and the healed tissues, if adequately cared for, will maintain their integrity for years.
PY - 1989 SP - 236 EP - 42 T2 - Annals of the Royal College of Surgeons of England TI - The surgical conservation of the neuropathic foot. VL - 71 SN - 0035-8843 ER -