Prevention of ulceration, amputation, and reduction of hospitalization: outcomes of a prospective multicenter trial of tibial neurolysis in patients with diabetic neuropathy |
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| Authors: | Dellon A Lee Muse Vickie L Nickerson D Scott Akre Thomas Anderson Sharon R Barrett Steve L Biddinger Kent R Bregman Peter J Bullard Bryan P Dauphinee Damien M DeJesus James M DeJesus Ramon A Ducic Ivica Dunkerly Jeffery Galina Michael R Hung Virginia Ichtertz Dolf R Kutka Michael F Jacoby Richard P Johnson J Barry Mader David W Maloney Christopher T Mancuso Peter J Martin R Craig Martin Rick F McDowel Brian A Rizzo Vito J Rose Michael Rosson Gedge D Shafiroff Bruce B Steck Jerome K Stolarski Raymond G Swier Patrick Wellens-Bruschayt Tatiana A Wilke Bronwyn Williams Eric H Wood Michael A |
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| Affiliation: | Department of Plastic Surgery, Johns Hopkins University, Baltimore, Maryland, USA. ALDellon@Dellon.com |
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| Abstract: | This is the first multicenter prospective study of outcomes of tibial neurolysis in diabetics with neuropathy and chronic compression of the tibial nerve in the tarsal tunnels. A total of 38 surgeons enrolled 628 patients using the same technique for diagnosis of compression, neurolysis of four medial ankle tunnels, and objective outcomes: ulceration, amputation, and hospitalization for foot infection. Contralateral limb tibial neurolysis occurred in 211 patients for a total of 839 operated limbs. Kaplan-Meier proportional hazards were used for analysis. New ulcerations occurred in 2 (0.2%) of 782 patients with no previous ulceration history, recurrent ulcerations in 2 (3.8%) of 57 patients with a previous ulcer history, and amputations in 1 (0.2%) of 839 at risk limbs. Admission to the hospital for foot infections was 0.6%. In patients with diabetic neuropathy and chronic tibial nerve compression, neurolysis can result in prevention of ulceration and amputation, and decrease in hospitalization for foot infection. |
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