Four-stage regimen for operative treatment of diabetic foot ulcer with deformity – Results of 300 patients

BackgroundAn 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.Methods and results335 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.Follow-up: 300 (90%) completed follow-up at 26 months on average (12–48 months). 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.ConclusionsThe 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.