Abdul Ghaffar, Ishtiaq Ahmed.
Treatment of non-healing Diabetic Foot Ulcers.
Pak Armed Forces Med J Jan ;52(1):17-20.

Non-healing diabetic ulcers can be one of the most frustrating conditions. An ulcer is classified as non-healing when there has been no clinical improvement or closure of the wound after four weeks of treatment. The main cause of non-healing nature of diabetic ulcer of the foot was excessive mechanical stresses in the ulcer base. The aim of this study was to establish a procedure, which can relieve the mechanical stresses at the ulcer base to achieve healing. Thirty-five diabetic patients with large, resistant ulcers on the planter surface of the toes were treated by resection of the metatarsal head through dorsal- median incision. Most of these ulcers had failed to heal with conservative measures including debridement and split thickness skin graft. The most common sites of ulceration were under the first metatarsal head and the planter aspect of the great toe. The ulcers had been present for a mean of 6.5ñ 2 months. They healed in a mean of 2.5ñ1.5 months after operation. Eight ulcers needed partial thickness skin grafts. There was no recurrence in the follow up for 24ñ8 months. Peripheral vascular disease did not affect the time required for ulcer healing. In 5 (14%) patients there was wound infection and in 3 (5%) the wound gapped after removal of stitches. No extremities were lost. None of the patients suffered any long-term sequelae. We recommend metatarsal head resection to achieve the healing of chronic diabetic foot ulcers overlying the metatarsophalangeal joints of the toes.

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