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Promoting primary healing after ray amputations in the diabetic foot: the plantar dermo-fat pad flap.

Abstract：

BACKGROUND:Amputation of the toe at the level of the distal metatarsal head (ray amputation) is a common surgical procedure in diabetic foot ulcers. The aim of this study was to introduce a new technique promoting primary healing by minimizing the dead space with the plantar dermo-fat pad flap after central ray amputation in diabetic foot ulcers. METHODS:Thirty-eight patients who had undergone central ray amputation and closure with the plantar dermo-fat pad flap between 1996 and 2003 were incorporated into the study. RESULTS:The mean follow-up period was 3.56 years. Single and multiple middle toe amputations were performed in 33 and five cases, respectively. In 14 cases with acute infection, split-thickness skin graft was used with the plantar dermo-fat pad flap to close the defect on the foot dorsum. Healing time was uneventful in all patients except three (8 percent), who were healed with local wound care. No patient showed signs of ulceration at the operative site during the follow-up. The mean time to total healing was 40.31 +/- 34.56 days. CONCLUSIONS:The plantar dermo-fat pad flap promotes primary wound healing after central ray amputation in diabetic foot ulcers by filling the dead space. The osteotomy to the base of the remaining adjacent metatarsal base in an effort to close the defect can be avoided by using the plantar dermo-fat pad flap; thus, undesirable angulation of the remaining parts of the foot can be eliminated. The plantar dermo-fat pad flap also supports the weak articular capsule of the adjacent metatarsophalangeal joints while covering the amputated metatarsal end. The thick, healthy plantar soft tissue advanced up to the width of the deepithelialized area reestablishes a good, tough plantar surface which--in association with the pad effect of the flap--decreases the recurrence rates and provides comfortable ambulation.

journal_name

Plast Reconstr Surg

journal_title

Plastic and reconstructive surgery

authors

Altindas M,Cinar C

doi

10.1097/01.prs.0000178400.62593.b1

subject

Has Abstract

pub_date

2005-09-15 00:00:00

pages

1029-34

issue

eissn

0032-1052

issn

1529-4242

pii

00006534-200509150-00017

journal_volume

116

pub_type

杂志文章

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Promoting primary healing after ray amputations in the diabetic foot: the plantar dermo-fat pad flap.