title: Multidisciplinary approach to soft-tissue reconstruction of the diabetic Charcot foot.
abstract: BACKGROUND
  Diabetics are prone to foot ulceration as a result of local tissue ischemia, immune impairment, and biomechanical derangement in the setting of neuropathy. Healing ulcers in the setting of Charcot neuroarthropathy is challenging, as the skeletal changes usually signify advanced disease.
  
  
  METHODS
  Records were reviewed for all patients with the diagnosis of Charcot neuroarthropathy and ulceration treated over a 7-year period. Demographic data, anatomical wound location, therapeutic interventions, and wound healing rates were recorded.
  
  
  RESULTS
  Three hundred fourteen wounds in 259 patients were examined. One hundred ninety-three wounds with documented follow-up data were analyzed. Fifty wounds (25.9 percent) were on the forefoot, 73 (37.8 percent) were on the midfoot, 28 (14.5 percent) were on the hindfoot, and 42 (21.8 percent) were about the ankle. Wounds were débrided surgically an average of four times. Primary closure was attempted in 29 wounds (15.0 percent). Delayed primary closure was attempted in 35 wounds (18.1 percent). Bioengineered alternative tissues were used in 61 wounds (31.6 percent). Autologous skin grafting was performed on 41 wounds (21.2 percent). Fifteen local flaps (7.8 percent) and five free flaps (2.6 percent) were performed. Forty-eight patients (31.6 percent) required a major amputation. Excluding patients who underwent major amputation, 95 wounds (65.1 percent) were healed at the time of final follow-up.
  
  
  CONCLUSIONS
  The majority of ulcers on Charcot feet required multiple débridements to achieve a clean wound. Multiple therapeutic modalities were used to achieve a 65 percent rate of healing. Despite those efforts, many patients required partial foot or major amputations, with more proximal wounds being at highest risk of the latter.
authors.affiliation: Washington, D.C. From the Departments of Plastic Surgery and Orthopedic Surgery, Medstar Georgetown University Hospital; and the Georgetown University School of Medicine.
authors.forename: Jeremy C
authors.initials: JC
authors.lastname: Sinkin
authors.forename: Megan
authors.initials: M
authors.lastname: Reilly
authors.forename: Alexis
authors.initials: A
authors.lastname: Cralley
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Kim
authors.forename: John S
authors.initials: JS
authors.lastname: Steinberg
authors.forename: Paul
authors.initials: P
authors.lastname: Cooper
authors.forename: Karen K
authors.initials: KK
authors.lastname: Evans
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Attinger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000379:methods / Q000706:statistics & numerical data; D000842:Ankle / Q000473:pathology / Q000601:surgery; D001174:Arthrodesis / Q000706:statistics & numerical data; D001177:Arthropathy, Neurogenic / Q000601:surgery*; D003131:Combined Modality Therapy; D015897:Comorbidity; D003646:Debridement / Q000706:statistics & numerical data; D017719:Diabetic Foot / Q000601:surgery*; D005260:Female; D005531:Foot Deformities, Acquired / Q000209:etiology / Q000473:pathology / Q000601:surgery; D006801:Humans; D018889:Ilizarov Technique / Q000706:statistics & numerical data; D008297:Male; D008511:Medicine; D008682:Metatarsal Bones / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D010027:Osteotomy / Q000706:statistics & numerical data; D010348:Patient Care Team; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000706:statistics & numerical data; D017768:Skin, Artificial / Q000706:statistics & numerical data; D013524:Surgical Flaps / Q000706:statistics & numerical data; D050277:Toe Phalanges / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome