DMRR special issue: Surgical interventions
Four articles in the special issue are written for a surgical audience
The first two deal with the Charcot foot, we have discussed the
Prof. Tagoe and his colleagues from the UK discuss the place of Achilles Tendon Lengthening. After some historical and surgical information on this procedure, they discuss the evidence for this procedure in relation to healing and prevention of diabetic foot ulcers. Achilles tendon lengthening has shown some very positive outcomes in well-performed randomized controlled trials, but has also resulted in a number of complications. They conclude there is a moderate level of evidence to support a place for Achilles tendon lengthening, but the jury is still out.
Hong and colleagues deal with a different and new method of surgery: super microsurgery. This type of surgery is applied for free-tissue transfer to the lower extremity, where arterial inflow and venous outflow to and from the flap is critical. To increase the success rate following microsurgery, Hong and colleagues applied a new method. This supermicrosurgery (blood vessels under 0.8mm) seeks small collateral vessels in the ischemia spared adjacent angiosome territory. Hong and colleagues describe the outcomes of their first 75 cases. An interesting approach, that needs further development and more research over the coming years to show its true value.
And as all surgeons rightly notice in their articles, no surgical procedure should be performed without inclusion of a multidisciplinary diabetic foot care team, before and after the operation.
http://onlinelibrary.wiley.com/doi/10.1002/dmrr.2745/abstract http://onlinelibrary.wiley.com/doi/10.1002/dmrr.2755/abstract http://onlinelibrary.wiley.com/doi/10.1002/dmrr.2750/abstract http://onlinelibrary.wiley.com/doi/10.1002/dmrr.2748/abstract