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Ostectomy and Medial Plantar Artery Flap Reconstruction for Charcot Foot Ulceration Involving the Midfoot.
J Foot Ankle Surg. 2016 May-Jun; 55(3):628-32.JF

Abstract

Charcot foot is a serious complication of diabetes, characterized by deformity and overlying ulceration. The condition most commonly affects the midfoot. However, little information is available on the use of a medial plantar artery flap to treat diabetic midfoot ulceration. The purpose of the present study was to evaluate the versatility of ostectomy and medial plantar flap reconstruction for midfoot plantar ulceration associated with rocker-bottom deformity secondary to Charcot foot. Four patients underwent ostectomy and medial plantar flap reconstruction. Before flap reconstruction, the devitalized soft tissues and bone were radically resected. After the infection had been controlled, the ulcerated portion was minimally excised, and the bony prominence underlying the ulcer was removed. A medial plantar artery flap was applied to the ulcer. The donor site was covered with a split-thickness skin graft or artificial dermis. In all patients, the ulcers healed and independent ambulation was achieved. However, 1 patient experienced ulcer recurrence, and subsequent infection necessitated a major amputation. Limb salvage is challenging in the setting of deformity and intractable plantar ulceration. The advantages of medial plantar artery flap reconstruction are that tissues with a rich blood supply are used to cover the exposed bone, and the flap can withstand the pressure and shear stress of the patient's body weight. However, a dominant artery in the foot is sacrificed. Therefore, the patency of the dorsalis pedis artery must be confirmed in every patient. The results of the present study have demonstrated that a medial plantar artery can be an effective alternative for diabetic patients with a plantar ulcer secondary to Charcot foot.

Authors+Show Affiliations

Assistant Professor, Department of Plastic and Reconstructive Surgery, Saitama Medical University, Saitama, Japan.Professor, Department of Plastic and Reconstructive Surgery, Saitama Medical University, Saitama, Japan. Electronic address: smuprs@gmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26190780

Citation

Sato, Tomoya, and Shigeru Ichioka. "Ostectomy and Medial Plantar Artery Flap Reconstruction for Charcot Foot Ulceration Involving the Midfoot." The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons, vol. 55, no. 3, 2016, pp. 628-32.
Sato T, Ichioka S. Ostectomy and Medial Plantar Artery Flap Reconstruction for Charcot Foot Ulceration Involving the Midfoot. J Foot Ankle Surg. 2016;55(3):628-32.
Sato, T., & Ichioka, S. (2016). Ostectomy and Medial Plantar Artery Flap Reconstruction for Charcot Foot Ulceration Involving the Midfoot. The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons, 55(3), 628-32. https://doi.org/10.1053/j.jfas.2015.05.005
Sato T, Ichioka S. Ostectomy and Medial Plantar Artery Flap Reconstruction for Charcot Foot Ulceration Involving the Midfoot. J Foot Ankle Surg. 2016 May-Jun;55(3):628-32. PubMed PMID: 26190780.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ostectomy and Medial Plantar Artery Flap Reconstruction for Charcot Foot Ulceration Involving the Midfoot. AU - Sato,Tomoya, AU - Ichioka,Shigeru, Y1 - 2015/07/16/ PY - 2014/02/10/received PY - 2015/7/21/entrez PY - 2015/7/21/pubmed PY - 2017/7/20/medline KW - Charcot neuroarthropathy KW - diabetes mellitus KW - limb salvage KW - medial plantar artery flap KW - plantar ulcer SP - 628 EP - 32 JF - The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons JO - J Foot Ankle Surg VL - 55 IS - 3 N2 - Charcot foot is a serious complication of diabetes, characterized by deformity and overlying ulceration. The condition most commonly affects the midfoot. However, little information is available on the use of a medial plantar artery flap to treat diabetic midfoot ulceration. The purpose of the present study was to evaluate the versatility of ostectomy and medial plantar flap reconstruction for midfoot plantar ulceration associated with rocker-bottom deformity secondary to Charcot foot. Four patients underwent ostectomy and medial plantar flap reconstruction. Before flap reconstruction, the devitalized soft tissues and bone were radically resected. After the infection had been controlled, the ulcerated portion was minimally excised, and the bony prominence underlying the ulcer was removed. A medial plantar artery flap was applied to the ulcer. The donor site was covered with a split-thickness skin graft or artificial dermis. In all patients, the ulcers healed and independent ambulation was achieved. However, 1 patient experienced ulcer recurrence, and subsequent infection necessitated a major amputation. Limb salvage is challenging in the setting of deformity and intractable plantar ulceration. The advantages of medial plantar artery flap reconstruction are that tissues with a rich blood supply are used to cover the exposed bone, and the flap can withstand the pressure and shear stress of the patient's body weight. However, a dominant artery in the foot is sacrificed. Therefore, the patency of the dorsalis pedis artery must be confirmed in every patient. The results of the present study have demonstrated that a medial plantar artery can be an effective alternative for diabetic patients with a plantar ulcer secondary to Charcot foot. SN - 1542-2224 UR - https://www.unboundmedicine.com/medline/citation/26190780/Ostectomy_and_Medial_Plantar_Artery_Flap_Reconstruction_for_Charcot_Foot_Ulceration_Involving_the_Midfoot_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1067-2516(15)00196-9 DB - PRIME DP - Unbound Medicine ER -