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MEDICINA E CHIRURGIA DELLA CAVIGLIA E DEL PIEDE
A Journal on Physiopathology and Surgery of the Foot
Indexed/Abstracted in: EMBASE, Scopus
Chirurgia Del Piede 2000 March;24(1):49-52
Surgical treatment of the perforating ulcer of the foot
Dalla Pria A., Conca M., Rossetti F.
Plantar ulceras in diabetic or arteriophatic patients are commonly difficult to treat due to several factors. Particularly the metatarsal trophic ulcerations, can be a very complex problem. This condition is basically produced by an eccessive pressure of the bone, consequently to an equine metatarsal head drop, upon a bad vascularized tissue or when a diabetic disorder can slaken or prevent the healing. Since 1993 we surgically treated 28 patients with perforating ulcer of the foot with no previous good results after different long term therapeutic protocols, including ozone and hyperbaric treatments. The surgical technique performed was a metatarsal osteotomy to revise the equine deformity in order to reduce the biomechanic overload as ulceration trigger. The trophic wound closure, after cauterization of the borders, was obtained with an ''S'' skin incision and a cutaneous suture with a 60° degrees' rotation of the skin flaps. After the suture removal (average time two weeks) full weight-bearing was allowed with a plantar orthesis. After a mean follow-up of one year, the overall functional rating was good and no recidivation observed.