Surgical revision of the problematic transmetatarsal amputation

1993 ◽  
Vol 83 (2) ◽  
pp. 91-95 ◽  
Author(s):  
BI Rosenblum ◽  
DV Freeman
Keyword(s):  
Diabetes Mellitus ◽  
Surgical Intervention ◽  
Skin Grafting ◽  
Surgical Revision ◽  
Local Resection ◽  
Conservative Care ◽  
Patients With Diabetes ◽  
Transmetatarsal Amputation

Recurrent ulcerations may develop following transmetatarsal amputation in patients with diabetes mellitus. In many cases, these ulcerations require surgical intervention to achieve healing, especially in situations where conservative care has not been effective. These procedures range from the local resection of bone to skin grafting and flap techniques to successfully heal the wound. The ultimate goal of any surgical intervention is to prevent a more proximal amputation.

Surgical Off-loading of the Diabetic Foot

2010 ◽  
Vol 100 (5) ◽  
pp. 369-384 ◽  
Author(s):  
Robert G. Frykberg ◽  
Nicholas J. Bevilacqua ◽  
Geoffrey Habershaw
Keyword(s):  
Diabetes Mellitus ◽  
High Risk ◽  
Diabetic Foot ◽  
Surgical Intervention ◽  
Surgical Decompression ◽  
Foot Ulcers ◽  
Foot Surgery ◽  
Patients With Diabetes

Surgical intervention for chronic deformities and ulcerations has become an important component in the management of patients with diabetes mellitus. Such patients are no longer relegated to wearing cumbersome braces or footwear for deformities that might otherwise be easily corrected. Although surgical intervention in these often high-risk individuals is not without risk, the outcomes are fairly predictable when patients are properly selected and evaluated. In this brief review, we discuss the rationale and indications for diabetic foot surgery, focusing on the surgical decompression of deformities that frequently lead to foot ulcers. (J Am Podiatr Med Assoc 100(5): 369–384, 2010)

Diabetes management in surgery

2011 ◽  
pp. 1905-1908
Author(s):  
Andrew P. Hall ◽  
Melanie J. Davies
Keyword(s):  
Diabetes Mellitus ◽  
Wound Healing ◽  
Stress Response ◽  
Diabetes Management ◽  
Metabolic Response ◽  
Skin Grafting ◽  
Metabolic Effects ◽  
Ophthalmic Surgery ◽  
Patients With Diabetes ◽  
Catabolic State

Diabetes mellitus is a common condition in the general population, and particularly so among hospital inpatients. Complications associated with diabetes mellitus further increase its incidence in surgical patients, particularly those requiring vascular, renal, or ophthalmic procedures. Patients with diabetes have a higher rate of morbidity and mortality associated with surgery. This includes cardiovascular and renal complications, infection, and impaired wound healing. The process of surgery, a controlled form of trauma, provokes a metabolic response due to the release of cytokines and stress-associated hormones. These agents promote a catabolic state that includes increased insulin resistance. The resulting hyperglycaemia leads to overflow of substrates in the mitochondria and the generation of excess free oxygen radicals, which can be toxic to the cell. It should, therefore, be possible to reduce these effects by avoiding or attenuating the stress response and/or counteracting its metabolic effects. The stress response is proportional to the degree of tissue trauma. Insulin administration and normoglycaemia have been shown to reverse catabolic changes and improve wound healing and skin grafting, and also to reduce the incidence of infective complications. Additionally, the stress response may be, in part, attenuated by the choice of anaesthetic technique. Neuraxial (spinal and epidural local anaesthetic) analgesia can reduce sympathetic nervous system tone and adrenal output. Additionally, much ophthalmic surgery is now performed with local anaesthesia techniques. Such approaches avoid the more prolonged starvation and cardiorespiratory risks associated with general anaesthesia.

Timing of peak plantar pressure during the stance phase of walking. A study of patients with diabetes mellitus and transmetatarsal amputation

2000 ◽  
Vol 90 (1) ◽  
pp. 18-23 ◽  
Author(s):  
VE Kelly ◽  
MJ Mueller ◽  
DR Sinacore
Keyword(s):  
Diabetes Mellitus ◽  
Stance Phase ◽  
Plantar Pressures ◽  
Skin Breakdown ◽  
Patients With Diabetes ◽  
Peak Plantar Pressure ◽  
Transmetatarsal Amputation ◽  
Footwear Design ◽  
Neuropathic Foot ◽  
Improved Methods

High plantar pressures contribute to skin breakdown in patients with diabetes mellitus and peripheral neuropathy. The primary purpose of this study was to determine the point during the stance phase of walking that corresponds with forefoot peak plantar pressures. Results indicate that peak plantar pressures occurred at 80% +/- 5% of the stance phase of gait in subjects with diabetes and transmetatarsal amputation, as well as in control subjects. Improved methods of footwear design or walking strategies proposed to patients should focus on the demands of the foot during the late stance phase of walking in order to increase available weightbearing area or to decrease forces, which will minimize plantar pressures and reduce trauma to the neuropathic foot.

TRANSMETATARSAL AMPUTATION FOR INFECTION OR GANGRENE IN PATIENTS WITH DIABETES MELLITUS

1949 ◽  
Vol 130 (4) ◽  
pp. 826-842 ◽  
Author(s):  
Leland S. McKittrick ◽  
John B. McKittrick ◽  
Thomas S. Risley
Keyword(s):  
Diabetes Mellitus ◽  
Patients With Diabetes ◽  
Transmetatarsal Amputation

Intramuscular Nerve and Neuromuscular Junction Alteration In Extraocular Muscles of Diabetic Mice

1985 ◽  
Vol 43 ◽  
pp. 682-683
Author(s):  
Bruce R. Pachter
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Nerves ◽  
Sudden Onset ◽  
Extraocular Muscles ◽  
Diabetic Patients ◽  
Oculomotor Palsy ◽  
Third Nerve Palsy ◽  
Patients With Diabetes ◽  
Intramuscular Nerve ◽  
Oculomotor Nerves

Diabetes mellitus is one of the commonest causes of neuropathy. Diabetic neuropathy is a heterogeneous group of neuropathic disorders to which patients with diabetes mellitus are susceptible; more than one kind of neuropathy can frequently occur in the same individual. Abnormalities are also known to occur in nearly every anatomic subdivision of the eye in diabetic patients. Oculomotor palsy appears to be common in diabetes mellitus for their occurrence in isolation to suggest diabetes. Nerves to the external ocular muscles are most commonly affected, particularly the oculomotor or third cranial nerve. The third nerve palsy of diabetes is characteristic, being of sudden onset, accompanied by orbital and retro-orbital pain, often associated with complete involvement of the external ocular muscles innervated by the nerve. While the human and experimental animal literature is replete with studies on the peripheral nerves in diabetes mellitus, there is but a paucity of reported studies dealing with the oculomotor nerves and their associated extraocular muscles (EOMs).

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