title: Prevention of ulceration, amputation, and reduction of hospitalization: outcomes of a prospective multicenter trial of tibial neurolysis in patients with diabetic neuropathy.
abstract: This is the first multicenter prospective study of outcomes of tibial neurolysis in diabetics with neuropathy and chronic compression of the tibial nerve in the tarsal tunnels. A total of 38 surgeons enrolled 628 patients using the same technique for diagnosis of compression, neurolysis of four medial ankle tunnels, and objective outcomes: ulceration, amputation, and hospitalization for foot infection. Contralateral limb tibial neurolysis occurred in 211 patients for a total of 839 operated limbs. Kaplan-Meier proportional hazards were used for analysis. New ulcerations occurred in 2 (0.2%) of 782 patients with no previous ulceration history, recurrent ulcerations in 2 (3.8%) of 57 patients with a previous ulcer history, and amputations in 1 (0.2%) of 839 at risk limbs. Admission to the hospital for foot infections was 0.6%. In patients with diabetic neuropathy and chronic tibial nerve compression, neurolysis can result in prevention of ulceration and amputation, and decrease in hospitalization for foot infection.
authors.affiliation: Department of Plastic Surgery, Johns Hopkins University, Baltimore, Maryland, USA. ALDellon@Dellon.com
authors.forename: A Lee
authors.initials: AL
authors.lastname: Dellon
authors.forename: Vickie L
authors.initials: VL
authors.lastname: Muse
authors.forename: D Scott
authors.initials: DS
authors.lastname: Nickerson
authors.forename: Thomas
authors.initials: T
authors.lastname: Akre
authors.forename: Sharon R
authors.initials: SR
authors.lastname: Anderson
authors.forename: Steve L
authors.initials: SL
authors.lastname: Barrett
authors.forename: Kent R
authors.initials: KR
authors.lastname: Biddinger
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Bregman
authors.forename: Bryan P
authors.initials: BP
authors.lastname: Bullard
authors.forename: Damien M
authors.initials: DM
authors.lastname: Dauphinee
authors.forename: James M
authors.initials: JM
authors.lastname: DeJesus
authors.forename: Ramon A
authors.initials: RA
authors.lastname: DeJesus
authors.forename: Ivica
authors.initials: I
authors.lastname: Ducic
authors.forename: Jeffery
authors.initials: J
authors.lastname: Dunkerly
authors.forename: Michael R
authors.initials: MR
authors.lastname: Galina
authors.forename: Virginia
authors.initials: V
authors.lastname: Hung
authors.forename: Dolf R
authors.initials: DR
authors.lastname: Ichtertz
authors.forename: Michael F
authors.initials: MF
authors.lastname: Kutka
authors.forename: Richard P
authors.initials: RP
authors.lastname: Jacoby
authors.forename: J Barry
authors.initials: JB
authors.lastname: Johnson
authors.forename: David W
authors.initials: DW
authors.lastname: Mader
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Maloney
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Mancuso
authors.forename: R Craig
authors.initials: RC
authors.lastname: Martin
authors.forename: Rick F
authors.initials: RF
authors.lastname: Martin
authors.forename: Brian A
authors.initials: BA
authors.lastname: McDowel
authors.forename: Vito J
authors.initials: VJ
authors.lastname: Rizzo
authors.forename: Michael
authors.initials: M
authors.lastname: Rose
authors.forename: Gedge D
authors.initials: GD
authors.lastname: Rosson
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Shafiroff
authors.forename: Jerome K
authors.initials: JK
authors.lastname: Steck
authors.forename: Raymond G
authors.initials: RG
authors.lastname: Stolarski
authors.forename: Patrick
authors.initials: P
authors.lastname: Swier
authors.forename: Tatiana A
authors.initials: TA
authors.lastname: Wellens-Bruschayt
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Wilke
authors.forename: Eric H
authors.initials: EH
authors.lastname: Williams
authors.forename: Michael A
authors.initials: MA
authors.lastname: Wood
authors.forename: William A
authors.initials: WA
authors.lastname: Wood
authors.forename: Michael P
authors.initials: MP
authors.lastname: Younes
authors.forename: Fuat
authors.initials: F
authors.lastname: Yuksel
mesh_terms: D000671:Amputation, Surgical; D002908:Chronic Disease; D017719:Diabetic Foot / Q000209:etiology / Q000517:prevention & control*; D003929:Diabetic Neuropathies / Q000601:surgery*; D005528:Foot / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D007239:Infections / Q000150:complications / Q000628:therapy; D009408:Nerve Compression Syndromes / Q000601:surgery*; D012008:Recurrence; D013979:Tibial Nerve / Q000601:surgery*