Maunika, A (2020) A Prospective Analysis on the Efficacy of Percutaneous Flexor Tenotomy Procedures in Rate of Healing and Recurrence of Diabetic Neuropathic Distal Toe Ulcer. Masters thesis, Government Mohan Kumaramangalam Medical College, Salem.
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Abstract
INTRODUCTION: One of the most devastating complications of diabetes is foot ulceration. One of the reasons why digital ulcers are very important is that they commonly precede limb amputations in diabetic patients upto 63.9% of the time. The early diagnosis, treatment and prevention is essential for prevention and management of diabetic ulcers and improve prognosis in the long term. In diabetes mellitus, the neuropathy is responsible for the decrease in the sensitivity which in turn lead to the loss of the reflexive protective sensation and in turn leads to toe deformities. METHODS: The aim of the study is to study the outcome and efficacy of flexor tenotomy procedure in the recurrence of diabetic distal toe ulcer and in the rate of healing of distal toe ulcer. From July 2017 to June 2019, a Prospective Single Center study was done among 50 patients admitted with diabetic neuropathic ulcer in the distal end of toes and all patients with toe deformity in GMKMC hospital. The following data was collected using a structured questionnaire: age, demographic characteristics, socio economic status, patients complaints and duration of complaints. A detailed clinical examination was done. Systemic examination and basic investigations were done. RESULTS: Patients between the age groups of 18 years and 60 years were included who were affected with diabetic neuropathic ulcer in the distal end of toes, presented with toe deformity and classified as Wagner’s classification 1 and 2. The mean age is 52 years. Among fifty patients, majority of them were males (n=33, 66%) while the rest were females (n=17, 34%). All patients in the study group were diagnosed with diabetes mellitus. The mean duration of type II DM was 36.06 months. Out of fifty patients, 68% (n=34) of them were on regular treatment while the remaining 32% (n=16) were on irregular treatment. The mean duration of ulcer was 38.35 days. Infection was present in 40% (n=20) of the patients. Rest of them did not have any infection (n=30, 60%). All of the patients had deformity. The neuropathic symptoms was present in 88% (n=44) of them .The x-ray of the affected limb showed the presence of osteomyelitis in 8% (n=4) of the cases. ABI was normal in all the patients. Flexor tenotomy was done in all the fifty patients. 80% (n=40) of them had a therapeutic tenotomy while 20% (n=10) of them had a prophylactic Tenotomy. The mean percentage reduction of ulcer in first week is 28.5%. The mean percentage reduction of ulcer in second week is 58.3%, in first month is 88.08% The mean percentage reduction of the ulcer in second month is 96.87% .In the group that had prophylactic tenotomy, all 10 patients did not have any ulcer during the study period. There were no complications at week one and week two. At the end of month one; there was one amputation and three transfer ulcers in the therapeutic group. Follow up 2-Month, 4-Month, 6-Month and One Year showed an increase in cure rates after flexor tenotomy in the therapeutic group and no ulcer in the prophylactic group. At the end of one year, the cure rate was 90% (n=36) with cured and transfer ulcers being 7.5% (n=3) and 2.5% (n=1) amputation. CONCLUSION: Diabetic foot ulcers are caused by a number of factors related to the architecture of the bone of foot, peripheral neuropathy and atherosclerotic peripheral arterial disease. All these factors lead to the infection of the foot .The stiffness of the ligaments in the disease is due to the nonenzymatic glycation. In diabetes mellitus, the neuropathy is responsible for the decrease in the sensitivity of the foot and thereby lead to the loss of the reflexive protective sensation which cause the mechanical stress to the otherwise normal foot during ambulation and lead to the complications. The insensate foot leads to poor reflexes during gait or weight bearing. Subsequently, there is more stress to the pressure points. Also, it results in callus formation. Long standing callus leads to tissue trauma and resultant ulcer. One of the main treatment goal is to off-load pressure from the sites of ulcer. This off-loading helps in the reduction of stress, pressure and callus formation enabling an environment for the healing of ulcer. Continual treatment helps in preventing the recurrence of the ulcer. The study shows that percutaneous tenotomy is very effective in the management of diabetic foot ulcers with better outcome and prognosis with better healing rates and lesser recurrence rates.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711407 |
| Uncontrolled Keywords: | Efficacy, Percutaneous Flexor Tenotomy Procedures, Rate of Healing and Recurrence, Diabetic Neuropathic Distal Toe Ulcer. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 12 Feb 2021 15:54 |
| Last Modified: | 12 Feb 2021 15:54 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14055 |
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