title: Ostectomy and Medial Plantar Artery Flap Reconstruction for Charcot Foot Ulceration Involving the Midfoot.
abstract: Charcot foot is a serious complication of diabetes, characterized by deformity and overlying ulceration. The condition most commonly affects the midfoot. However, little information is available on the use of a medial plantar artery flap to treat diabetic midfoot ulceration. The purpose of the present study was to evaluate the versatility of ostectomy and medial plantar flap reconstruction for midfoot plantar ulceration associated with rocker-bottom deformity secondary to Charcot foot. Four patients underwent ostectomy and medial plantar flap reconstruction. Before flap reconstruction, the devitalized soft tissues and bone were radically resected. After the infection had been controlled, the ulcerated portion was minimally excised, and the bony prominence underlying the ulcer was removed. A medial plantar artery flap was applied to the ulcer. The donor site was covered with a split-thickness skin graft or artificial dermis. In all patients, the ulcers healed and independent ambulation was achieved. However, 1 patient experienced ulcer recurrence, and subsequent infection necessitated a major amputation. Limb salvage is challenging in the setting of deformity and intractable plantar ulceration. The advantages of medial plantar artery flap reconstruction are that tissues with a rich blood supply are used to cover the exposed bone, and the flap can withstand the pressure and shear stress of the patient's body weight. However, a dominant artery in the foot is sacrificed. Therefore, the patency of the dorsalis pedis artery must be confirmed in every patient. The results of the present study have demonstrated that a medial plantar artery can be an effective alternative for diabetic patients with a plantar ulcer secondary to Charcot foot.
authors.affiliation: Assistant Professor, Department of Plastic and Reconstructive Surgery, Saitama Medical University, Saitama, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Sato
authors.affiliation: Professor, Department of Plastic and Reconstructive Surgery, Saitama Medical University, Saitama, Japan. Electronic address: smuprs@gmail.com.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Ichioka
mesh_terms: D000328:Adult; D001177:Arthropathy, Neurogenic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D003131:Combined Modality Therapy; D017719:Diabetic Foot / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005529:Foot Bones / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012494:Sampling Studies; D013524:Surgical Flaps / Q000098:blood supply* / Q000637:transplantation*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*
keywords: Charcot neuroarthropathy; diabetes mellitus; limb salvage; medial plantar artery flap; plantar ulcer