Neuropathic ulcerations plantar to the lateral column in patients with Charcot foot deformity: a flexible approach to limb salvage.

Abstract

Neuroarthropathy of the midfoot may lead to a structural deformity that predisposes the diabetic patient to skin breakdown and ulceration. In some cases, conservative management is not adequate, making surgical intervention necessary. The authors performed a retrospective study to look at those patients who required surgical intervention for a specific pattern of neuroarthropathy. Over a 2 1/2-year period, 32 feet (31 patients) underwent surgical procedures for treatment of nonhealing neuropathic ulcerations beneath the lateral column of Charcot feet. All feet underwent exostectomy with 17 undergoing excision of the ulcer with primary closure, 8 closure via rotational fasciocutaneous flap with transpositional intrinsic muscle flap, and 6 through an incision placed adjacent to the ulcer. One patient whose ulcer was healed at the time of surgery had the incision placed directly over the prominence. Overall, 29 of 32 feet maintained functional limb salvage. This included eight patients who required revisional surgery, either by resection of more bone or creation of a local flap for coverage. Life-table analysis resulted in an 89% overall success rate. The results show that a flexible approach to skin and soft tissue coverage is necessary to heal these patients, provided attention is directed to the underlying bony prominence.