Document Detail

Achilles tendon lengthening: friend or foe in the diabetic foot?
MedLine Citation:
PMID:  23271552     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Literature in the past decade has shown that Achilles tendon-lengthening surgery in addition to total contact casting decreases the rate of plantar ulcer recurrence in the forefoot and midfoot; however, the risk of heel ulceration or recurrent equinus deformity with new forefoot or midfoot wounds is not insignificant. The purpose of this study was to compare the rate of recurrent ulceration between the patient groups who have undergone soft-tissue repair of diabetic forefoot or midfoot wounds either with or without concomitant Achilles tendon-lengthening surgery.
METHODS: All diabetic patients with plantar forefoot or midfoot ulceration who underwent soft-tissue reconstruction during two different time periods-from 1983 to 1991 or from 1996 to 2004-were reviewed. Multiple patient-related factors were compared. The "early group" consisted of 179 wounds in 149 patients who underwent wound closure surgery alone. The "later group" included 145 wounds in 138 patients who underwent similar wound closure procedures with the addition of Achilles tendon-lengthening surgery.
RESULTS: Twenty-five percent in the early group and 2 percent of patients in the later group developed recurrent ulceration requiring reoperation, which resulted in 94 percent relative risk reduction (p < 0.001), whereas the risk factors and demographic data were similar in each group. In addition, 12 percent in the early group and 4 percent of the later group developed transfer lesions (p < 0.001).
CONCLUSION: If one avoids excessive Achilles lengthening, the addition of an Achilles tendon-lengthening procedure can significantly reduce the risk of recurrent diabetic foot ulcerations.
Lawrence B Colen; Claudia J Kim; William P Grant; Jiun-Ting Yeh; Baydoun Hind
Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  131     ISSN:  1529-4242     ISO Abbreviation:  Plast. Reconstr. Surg.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-28     Completed Date:  2013-02-25     Revised Date:  2014-10-13    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  37e-43e     Citation Subset:  AIM; IM    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Achilles Tendon / surgery*
Aged, 80 and over
Diabetic Foot / prevention & control*,  surgery
Follow-Up Studies
Middle Aged
Proportional Hazards Models
Reconstructive Surgical Procedures*
Recurrence / prevention & control
Reoperation / statistics & numerical data
Retrospective Studies
Treatment Outcome
Wound Closure Techniques

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  The V-Y advancement flap is equivalent to the Mustardé flap for ectropion prevention in the reconst...
Next Document:  Treatment of soft-tissue loss with nerve defect in the finger using the boomerang nerve flap.