A retrospective audit of lesion excision and rotation skin flap for the treatment of intractable plantar keratosis

Saipoor, Amir; Maher, Anthony; Hogg, Lance

doi:10.1016/j.foot.2017.09.004

Cited by 2 publications

(5 citation statements)

References 18 publications

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“…14 Saipoor et al performed a retrospective audit of the literature showing the technique to be an effective and safe single-stage procedure to achieve closure of excised plantar foot lesions. 15 Although largely benign, epidermal inclusion cysts with potential for subsequent giant-cell reaction must remain a part of an exhaustive differential diagnosis in the evaluation of plantar foot soft-tissue masses. These lesions can be successfully treated with single-stage primary excision and rotational flap closure as demonstrated in this case.…”

Section: Discussionmentioning

confidence: 99%

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Epidermal inclusion cyst with foreign-body giant-cell reaction treated with surgical excision and rotational flap closure: A case report

Preston

Johnson

Thomas

2018

Proceedings of Singapore Healthcare

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Epidermal inclusion cysts (epidermoid cysts) occur from penetration of epidermal cells into underlying dermal tissue. They are most commonly found on the scalp, face, neck, and back with a reported incidence of 10% on the extremities. We present the case of a 53-year-old female who presented with complaint of a painful plantar forefoot soft-tissue mass of insidious origin. After magnetic resonance imaging, she was treated with surgical excision and plastic rotational flap closure. The surgical site healed without incident, and she was able to ambulate pain free in her normal footwear with full weight bearing and no shoe modifications or orthotics. This case was novel in that the size of the lesion required the use of a uni-lobe full-thickness rotational skin flap to achieve complete tension-free closure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Epidermal inclusion cyst with foreign-body giant-cell reaction treated with surgical excision and rotational flap closure: A case report

Preston

Johnson

Thomas

2018

Proceedings of Singapore Healthcare

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“…Conservative treatment are currently offered to patients with IPK, but they are unsatisfactory since they do not offer a sufficient or permanent reduction of symptoms [ 26 , 27 ]. If conservative treatments fail, surgical treatments such as arthroplasty, bunionectomy, osteotomy, skin flap and punch biopsy are offered [ 21 , 27 – 29 ]. However, it has been reported that IPK’s surgical management can lead to transfer lesions because plantar pressure points are relocated [ 27 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

“…If conservative treatments fail, surgical treatments such as arthroplasty, bunionectomy, osteotomy, skin flap and punch biopsy are offered [ 21 , 27 – 29 ]. However, it has been reported that IPK’s surgical management can lead to transfer lesions because plantar pressure points are relocated [ 27 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

“…Despite the different types of treatment currently available for IPKs (keratolytic ointments, partial offloading with orthotic devices, insoles, paddings and therapeutic shoes, moisturizers and emollients, bleomycin sulfate or hyaluronic acid or silicone injections), the treatment of choice is scalpel debridement alone [4,[15][16][17][18][19][20][21][22][23][24][25]. Conservative treatment are currently offered to patients with IPK, but they are unsatisfactory since they do not offer a sufficient or permanent reduction of symptoms [26,27]. If conservative treatments fail, surgical treatments such as arthroplasty, bunionectomy, osteotomy, skin flap and punch biopsy are offered [21,[27][28][29].…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of saline water and lidocaine injection treatment of intractable plantar keratoma: a randomised feasibility study

Mercier

Blanchette

Cantin

et al. 2021

Journal of Foot and Ankle Research

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Background An intractable plantar keratoma (IPK) is a conical thickening of the epidermis’ stratum corneum and a common cause of foot pain which can have a significant, detrimental impact on the mobility, quality of life and independence of individuals. Conservative treatments are currently offered to patients with IPK, but they are unsatisfactory since they do not offer a sufficient or permanent reduction of symptoms. The purpose of this study was the evaluation of the feasibility, safety and effectiveness of innovative treatments for intractable plantar keratoma (IPK). Methods A randomized single blind trial with 40 patients divided with block randomization in four parallel groups was conducted to compare treatment combinations: conservative sharp debridement only or sharp debridement with needle insertion, physiological water injection or lidocaine injection. All patients obtained the same treatment four times at a four-week interval. At each visit, visual analog scale (VAS), Foot Function Index (FFI) and IPK size were evaluated. VAS and FFI were also completed at a six and twelve-month follow-up. Results Our findings in regards to feasibility demonstrated recruitment challenges because of the anticipated pain that would be provoked by needle insertion may not be worth the potential pain relief compared to debridement alone from the patient’s perspective. This was also the principal cause of drop out. Our preliminary results show no main effect of group for any of the clinical outcomes: pain felt on VAS, FFI score, IPK’s size (p > 0.05). However, the analysis revealed a statistically significant effect of time on VAS (p < 0.001), FFI score (p < 0.001) and IPK’s size (width and depth (p < 0.001); length (p = 0.001)), but no group x time interaction was found (p > 0.05). Conclusions This study demonstrates that IPK treatment consisting of sharp debridement with needle insertion, physiological saline water injection or lidocaine injection is feasible and safe. There was a non-statistically significant trend toward diminishing pain intensity compared to scalpel debridement alone. The pain provoked by needle insertion and injection treatments must be addressed with a scientifically proven protocol to make it more comfortable for patients before these treatments could be considered in further studies. Trial registration ClinicalTrials.gov, NCT04777227. 2 March, 2021 - Retrospectively registered (All participants were recruited prior to registration).

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A retrospective audit of lesion excision and rotation skin flap for the treatment of intractable plantar keratosis

Cited by 2 publications

References 18 publications

Epidermal inclusion cyst with foreign-body giant-cell reaction treated with surgical excision and rotational flap closure: A case report

Epidermal inclusion cyst with foreign-body giant-cell reaction treated with surgical excision and rotational flap closure: A case report

Effectiveness of saline water and lidocaine injection treatment of intractable plantar keratoma: a randomised feasibility study

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