Anterior superior iliac spine distraction for severe and recalcitrant diabetic foot ulcers |
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| Affiliation: | 1. Department of Orthopaedics, People''s Hospital of Chuxiong Yi Autonomous Prefecture, Chuxiong, Yunnan 675000, China;2. Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China;3. Department of Orthopaedics, People''s Hospital of Xishuangbanna State, Yunnan, China;4. Department of Orthopaedics, People''s Hospital of Mile City of Honghe State, Yunnan, China;1. Department of Orthopaedics, 920 Hospital of the Joint Logistics Support Force of the PLA, 212 Daguan Road, Kunming 650032, China;2. Department of Orthopaedics, Taian Municipal Hospital, 1 Yincai Street, Taian 271000, China;3. Department of Orthopaedics, First affiliated hospital, Army Medical University, Chongqing 404199, China;1. Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan;2. Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan;3. Department of Neurosurgery, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan;4. Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Centre, Tokyo, Japan;1. Department of Radiology, APHM, Timone Hospital, Marseille, France;2. Department of Vascular Surgery, APHM, Timone Hospital, Marseille, France |
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| Abstract: | PurposeThe study aimed to introduce anterior superior iliac spine distraction to treat severe and recalcitrant diabetic foot ulcers. For comparison, we also included another group of diabetic foot ulcers treated with proximal tibial cortex transverse distraction.MethodsFrom February 1998 to February 2020, 87 patients (87 feet) with severe and recalcitrant diabetic foot ulcers were treated. The mean age of patients at surgery was 64 years (range, 47 to 87 years). The severity of the narrowed artery was assessed using the ankle-brachial index test. For comparison, another group of 91 patients (91 diabetic foot ulcers) treated with proximal tibial cortex transverse distraction was included.ResultsThe mean preoperative ankle-brachial indexes of the two groups were 0.41±0.07 and 0.39±0.05 (OR 0.65 [95% CI -0.77 to 1.58]; P=0.62), respectively. The mean preoperative limb pain was 3.42±2.84 cm and 3.52±3.11 cm (OR 1.54 [95% CI -077 to 1.35]; P=0.083), respectively. At the 2-year follow-up visit, ulcers healed in 72 (83%) and 74 (81%) patients, respectively (P=0.188). The mean postoperative limb pain was 0.52±0.23 cm and 0.49±0.41 cm (OR 2.32 [95% CI -0.27 to 1.66]; P=0.078), respectively. Pin-site infection occurred in 2 patients and 8 patients (P=0.09), respectively. Ulcer recurrence occurred in 13 (15%) patients and 15 (16%) patients (P=0.205), respectively.ConclusionsAnterior superior iliac spine transverse distraction may be an effective alternative treatment for severe and recalcitrant diabetic foot ulcers. It may be associated with fewer distraction-site complications than proximal tibial cortex transverse distraction.Level of evidenceTherapeutic study, Level IIa. |
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