A novel treatment for plantar ulcers in leprosy: local superficial flaps

Gahalaut, Pratik; Pinto, Jerome; Pai, C. Ganesh; Kamath, Jagannath B; Joshua, Thangam Verghese

doi:10.47276/lr.76.3.220

Cited by 26 publications

(21 citation statements)

References 8 publications

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“…Today, it is widely known that the exclusive use of skin grafts should not be considered as the first therapeutic option, due to the low weight-bearing capacity, associating with a high rate of chronic ulceration [16][17][18]. As a result, the indiscriminate use of regional flaps became a frequent practice, with the advance flaps in V-Y [19][20][21], rotational and transposition standing out [22]. However, these have been linked with restrictions in the arches of movement, comorbidities in the donor area, joint stiffness, late limb amputations, and border hyperkeratosis; therefore, their use has been limited for the recon-struction of suprafascial defects with small size [8,16,17].…”

Section: Discussionmentioning

confidence: 99%

Subunit Principle: Key Element for Plantar Reconstruction with Free Sensate Flaps

Sanchez

Gallardo

Espinoza

et al. 2021

Arch Hand Microsurg

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Purpose: Plantar wounds represent a frequent practice of the plastic and reconstructive surgeon. The uniqueness and high complexity of the microarchitecture and biomechanics of the plantar region explain the complex challenge of its reconstruction. With the advances in microsurgery, including the plantar subunit principle, both applied in the restoration of plantar defects through the use of sensorineural free flaps have allowed an optimal reconstruction.Methods: A descriptive, retrospective study was carried out in a period of time established between January 2016 and January 2019, obtaining a total of 18 patients with plantar defects, reconstructed using sensory free flaps. Tissue stability, recovery of protective sensitivity, early ambulation, and correct use of footwear were evaluated.Results: The most frequent etiology was secondary to oncological resections due to melanoma (n = 12, 66.7%), followed by gunshot wounds (n = 4, 22.2%). Subunit 3 was the most frequently involved in 38.9% (n = 7). In the 88.8% of the cases, was used an anterolateral thigh flap (n = 16) and the lateral antebrachial flap in 22.2% (n = 2). The free flap survival rate was 100%. An average of seven points was obtained at 6 months based on the Semmes-Weinstein test. The mean for the return to their daily activities was 2.5 months. The patients of 94.4% (n = 17) recovered ambulation and could footwear. Conclusion: The reconstruction of plantar defects must have a systematic approached, taking the subunit principle as a central point. The treatment of plantar defects with sensorineural free flaps represent an unprecedented option for optimal reconstruction.

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Section: Discussionmentioning

confidence: 99%

Subunit Principle: Key Element for Plantar Reconstruction with Free Sensate Flaps

Sanchez

Gallardo

Espinoza

et al. 2021

Arch Hand Microsurg

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“…Patients managed with rest and dressings have some foci of residual inflammation, and recur soon after the patient is mobilized. [ 4 ] For smaller defects, the best method of resurfacing plantar ulcers is use of local tissue. For medium-sized defects plantar artery skin fascia flap by Reiffel,[ 5 ] a medial plantar flap with a lateral plantar pedicle by Martin[ 6 ] and reverse medial plantar artery flap by Gravem[ 7 ] are useful adjuncts.…”

Section: Discussionmentioning

confidence: 99%

Free tissue transfer for trophic ulcer complicating leprosy

Bhatt

Panse

Vyas

et al. 2009

Indian J Plast Surg

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Plantar ulceration is the commonest disability in leprosy and occurs in about 10 to 20% of leprosy patients. Various loco-regional flaps have been described for reconstruction of trophic ulcers; however, very large defects are not amenable to local flaps and free flaps form one of the important treatment options. We present a case of a post Hansen's trophic ulcer over the forefoot managed using a radial artery forearm free flap. Debridement of the osteomyelitic bone, removal of the bony prominences, coverage by a well-vascularised tissue, end-to-side arterial anastomosis, use of anterior tibial as the recipient vessel and good postoperative compliance in foot care on the part of the patient gave us good results.

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“…Treatment of ulcers scraping and oiling have been traditionally used for the restoration of the dry skin to its normal level of suppleness. 4 Other reported treatments include antibiotic therapy-MDT (Multi drug therapy) [2] , crutch walking, POP boot or B.K Plaster, dressing by using gauze pieces, bandage rolls betadine solution, soap and Savlon, Static dynamic splinting [4,9] surgery with local superficial flaps [6] , toe web flap [7] , Self care foot soaks [11] , cuneo-metatarsal articulation [21] , surgical decompression [22] .…”

Section: Factors Affecting Wound Healingmentioning

confidence: 99%

Effect of active resisted exercise on plantar ulcer in subjects with leprosy

Basavaraju¹,

George²

2021

Int. J. Phys. Educ. Sports Health

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Background of the study: Leprosy is a wide spread infectious disease caused by mycobacterium leprae & usually starts as a patch on the skin, but it can also affect & damage the nerves leading to secondary impairments in the face, hands and feet. Plantar ulceration is one of the common impairment occurring in subjects of leprosy, which punched out ulcer surrounded by thickened skin due to direct pressure, shearing force, direct injury, heat. It may occur as sinuses or as shallow ulcers involving the tissues at various level and usually heal with good wound care and dressings, but takes longer time.Objective of the study: To evaluate and compare the improvement of healing of plantar ulcer during 4week intervention period in leprosy subjects treated with active resisted exercise vs subjects treated conventionally. Methods Design: Quasi randomised trial.Study settings: The central leprosum, govt hospital, magadi road, bengaluru. Sample size: 26 Outcome measures: Wound area measurement in mm 2 on a graph paper. Results:The mean value of ulcer area at baseline for group A was 1038.15(599.77) mm 2 & group B was 997.07(804.47) mm 2 and at day 30 the value for group A is 318(311.65) mm 2 & for group B is 720.84(673.19) mm 2 . This study showed a significant improvement in reduction of ulcer area in both the groups. Group A demonstrated significantly better improvements than Group B. Conclusion: Active resisted exercise showed a significant improvement in healing of planter ulcer of leprosy subjects compared to control group.

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A novel treatment for plantar ulcers in leprosy: local superficial flaps

Cited by 26 publications

References 8 publications

Subunit Principle: Key Element for Plantar Reconstruction with Free Sensate Flaps

Subunit Principle: Key Element for Plantar Reconstruction with Free Sensate Flaps

Free tissue transfer for trophic ulcer complicating leprosy

Effect of active resisted exercise on plantar ulcer in subjects with leprosy

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