title: Gastrocnemius fascia release under local anaesthesia as a treatment for neuropathic foot ulcers in diabetic patients: a short series.
abstract: BACKGROUND
  Diabetic foot ulceration is the leading cause of major amputation in the developed world. Plantar neuropathic ulcers at the forefoot can be managed conservatively with off-loading, but treatment is not invariably successful. Achilles tendon lengthening procedures aim at increasing dorsiflexion and decreasing forefoot pressure but can be associated with complications and require prolonged postoperative immobilization to prevent tendon rupture. We assessed the feasibility and clinical outcome of a comparative minimal invasive procedure: the gastrocnemius fascia release. This technique targets the same goals but is performed under local anaesthesia and allows immediate postoperative weight bearing and ambulation.
  
  
  METHODS
  Diabetic patients with plantar neuropathic ulcers Wagner grade 2 or 3 were recruited from our diabetic foot clinic. Patients with infected wounds or untreatable peripheral arterial disease were excluded from the study. Conservative treatment with off-loading and local wound care was attempted for six weeks and surgical procedure only contemplated upon failure. Primary end-points were improved range of dorsiflexion and time to healing. Secondary end-points were local ulcer recurrences, new plantar ulcers, and minor or major amputation. Post-operative follow-up was 12 months.
  
  
  RESULTS
  Seven patients were included in the study. An improvement in dorsiflexion of 10.4° (mean) was recorded post-operatively (p < 0.01). After 30 days, complete healing was accomplished in six of the seven patients. Long-term results were excellent as no ulcer recurrence or amputation was noted.
  
  
  CONCLUSIONS
  Gastrocnemius fascia release under local anaesthesia can be performed safely in diabetic patients with plantar neuropathic ulcers under the metatarsal heads. Clinical outcome is excellent and long-term results promising.
authors.affiliation: a Department of Vascular Surgery , Algemeen Stedelijk Ziekenhuis (ASZ) , Aalst , Belgium.|b Department of Vascular Surgery , Universitair Ziekenhuis Brussel (VUB) , Jette , Belgium.
authors.forename: Kobe
authors.initials: K
authors.lastname: Van Bael
authors.affiliation: a Department of Vascular Surgery , Algemeen Stedelijk Ziekenhuis (ASZ) , Aalst , Belgium.
authors.forename: Geerhardus
authors.initials: G
authors.lastname: Van der Tempel
authors.affiliation: a Department of Vascular Surgery , Algemeen Stedelijk Ziekenhuis (ASZ) , Aalst , Belgium.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Claus
authors.affiliation: a Department of Vascular Surgery , Algemeen Stedelijk Ziekenhuis (ASZ) , Aalst , Belgium.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Speybrouck
authors.affiliation: a Department of Vascular Surgery , Algemeen Stedelijk Ziekenhuis (ASZ) , Aalst , Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: De Coster
authors.affiliation: a Department of Vascular Surgery , Algemeen Stedelijk Ziekenhuis (ASZ) , Aalst , Belgium.
authors.forename: Sylvie
authors.initials: S
authors.lastname: De Laere
authors.affiliation: b Department of Vascular Surgery , Universitair Ziekenhuis Brussel (VUB) , Jette , Belgium.
authors.forename: Erik
authors.initials: E
authors.lastname: Debing
authors.affiliation: b Department of Vascular Surgery , Universitair Ziekenhuis Brussel (VUB) , Jette , Belgium.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Aerden
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D000328:Adult; D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D003928:Diabetic Nephropathies / Q000150:complications*; D000071938:Fasciotomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D016523:Foot Ulcer / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors
keywords: Diabetes; diabetic foot; fasciotomy; gastrocnemius; neuropathy; surgery