title: Four-stage regimen for operative treatment of diabetic foot ulcer with deformity - a results of 300 patients.
abstract: BACKGROUND
  An operative four-stage regimen (stage 1, debridement; stage 2, closure; stage 3, unloading; stage 4, correction) for operative treatment of diabetic foot ulcer with deformity, and first clinical results are introduced.
  
  
  RESULTS
  335 patients entered stage 1 between 01/09/2006 and 31/08/2010. Stage 1: In 189 cases (56%), one debridement resulted in sterile postoperative specimens. Stage 2: 210 cases (63%) sustained secondary closure, 97 (29%) local shifted skin graft, and 20 (6%) functional amputation. Stage 3: 304 (90%) finished stage 3, 14 (4%) presented with recurrent ulcer. Stage 4: In 185 cases (55%), correction arthrodeses were performed successfully.
  
  
  RESULTS
  300 (90%) completed follow-up at 26months on average (12-48months). Recurrent ulcer was registered in 46 (15%). Overall amputation rate was 14%, the majority at digital or midfoot level. Four cases (1%) required a below-knee amputation.
  
  
  CONCLUSIONS
  The management of diabetic foot ulcer combined with deformity with the introduced regimen showed low major amputation rate and low recurrent ulcer rate compared with the literature.
authors.affiliation: Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany. info@foot-surgery.eu
authors.forename: Martinus
authors.initials: M
authors.lastname: Richter
authors.forename: Stefan
authors.initials: S
authors.lastname: Zech
mesh_terms: D048909:Diabetes Complications / Q000150:complications / Q000601:surgery*; D017719:Diabetic Foot / Q000150:complications / Q000601:surgery*; D005260:Female; D005531:Foot Deformities, Acquired / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D013514:Surgical Procedures, Operative / Q000379:methods