Journal Reading BTKV

Comparison of Metatarsal Head

Resection Versus Conservative Care
in Treatment of Neuropathic
Diabetic Foot Ulcers

Arie R Singara
 INTRODUCTION
• Diabetic foot ulcer (DFU) found in 12-25%
patient with Diabetes Melitus (DM)
• About 85% lower limb amputation  result
from DFU
• DFU  lower quality (health related) of life
(compare to other patients with DM but no
DFU)
 Metatarsal Head Resection (MHR)
• First described in early 1950s
• Effective procedure for treatment deformities in
forefoot
• Main procedure :
– Excising metatarsal head and part of its neck through
one plantar incision
• The procedure was affected by :
– Technique-related factor (stump preparation, pattern
of resection, planned instrumentation)
– Patient-related factor (the underlying disorders)
Metatarsal Head Resection (MHR)
• Plantar aspect of metatarsal head  common
location for ulcer formation
• The surgical procedure help the ulcerated
wound to heal  no over-loading
biomechanical forces
Metatarsal Head Resection (MHR)
 MATERIAL AND METHOD
• Method : Retrospective cohort study
• Sample :
– Group 1 : 20 patient with DM with 24 neuropathic foot
ulcers
– Group 2 (control) : 20 patient with DM with 25 neuropathic
foot ulcers (same anatomic region with group 1)
• Group 1
– surgery MHR + dressing daily + plaster splint until 2 weeks
• Group 2
– non-operative (non-weight bearing, antibiotic, “Coloplast”
dressing, ointment, moisturizers, irrigation with normal
saline, and spezialized footwear)
 MATERIAL AND METHOD
• All patient were classified using Wagner Grading
System
– All wagner I and II were included
• All pressure ulcers must be beneath
metatarsophalangeal joints
• All patient consulted to vascular surgeon to find any
vascular disease, if yes  excluded
• All post-operative patient can do weightbearring and
walking indoor
• All patient blood glucose is optimalize before
• All data analysed using SPSS version 16.0 with p value
significant at <0,05
RESULT
RESULT
RESULT
 DISCUSSION
• Principally amputation is specified to
ireversible and extensive diabetic foot lession
 lead to disability and disturbed quality of
life
• Team assesment of the wound healing 
More ulcer recurrence and more infection at
medical group
• MHR  can preserve efficient and functional
limb
 DISCUSSION
• Some similar study to this journal
• Pieggassi et al, demostrated the high efficacy of
MHR for patient with DM that surgical treatment
of neuropathic foot ulcers in diabetic patient is an
effective approach compared to conventional
– Healing rate 95,5% vs 79,2%
– Healing time 46,73 ± 38,94 days vs 128,9 ± 86,6 days
– Complication 4,5% vs 12,5%
– Relapse 3 vs 8
 DISCUSSION
• Griffith and Wieman
– Ulcers healed in mean 2,4 ± 1,6 months post MHR
– Rare complication (1 hematome, 1 wound
infection, no long term sequele)
• Wieman et all
– 88% ulcer healed more rapid after MHR
• Patel and Wieman
– 6-10 weeks ulcer healed after MHR
 DISCUSSION
• MHR has several adventages :
– Can be done under local anestesia  minimal risk
– A single procedure
– Wound can be closed primarily
– Allow rapid return to weightbearing
– Limiting disability
– Allow rapid recovery
 CONCLUTION
• MHR has demonstrated the complete
superiority compare to medical approach :
– Fewer complication
– Fewer ulcer recurrence
– Fewer length of hospitalization
– Cost effective
– Faster and better wound healing
• MHR is a better treatment than the medical
approach alone
THANK YOU