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J Reconstr Microsurg 2012; 28(04): 241-246
DOI: 10.1055/s-0032-1306372
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Prevention of Ulceration, Amputation, and Reduction of Hospitalization: Outcomes of a Prospective Multicenter Trial of Tibial Neurolysis in Patients with Diabetic Neuropathy

A. Lee Dellon
1   Department of Plastic Surgery, Johns Hopkins University, Baltimore, Maryland
2   Dellon Institute for Peripheral Nerve Surgery, Peripheral Nerve Towson, Baltimore, Maryland
,
Vickie L. Muse
2   Dellon Institute for Peripheral Nerve Surgery, Peripheral Nerve Towson, Baltimore, Maryland
,
D. Scott Nickerson
3   Northeast Wyoming Wound Care Center, Sheridan, Wyoming
,
et al › Author Affiliations
Further Information

Publication History

13 August 2011

16 October 2011

Publication Date:
12 March 2012 (online)

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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.

Keywords

ulcers - amputation - diabetic neuropathy
 

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