Abstract

Objective: To assess the effectiveness and safety of the combination of z-plasty lengthening of Achilles tendon.
Study Design: Sixty-two neuropathic forefoot ulceration in fifty-four diabetic subjects were included on this prospective, Open, Uncontrolled, Non Randomized, Observational study. The eligibility criteria included normal physical activity with no antecedent of minor amputation, and an ankle dorsiflexion range of motion (DF-ROM) minor of 15 degrees measures with goniometer. Eligible patients were referred to the Vascular Surgery Service of the Clinic Surgical Hospital “José R. Lopez Tabrane” in Matanzas, Cuba from January 2009 to May 2015. The follow-up process ends in December 2016. Based on non-probability consecutive sampling thirty-one patients with thirty-five neuropathic forefoot ulcerations (NFU) were included in the treatment group and twenty-three patients with twentyseven NFU in the control. plus intralesional administration of human recombinant Epidermal Growth Factor in the reduction of the recidivism of neuropathic forefoot ulceration.
Results: Sixty-two neuropathic forefoot ulceration in fifty-four diabetic subjects who met the eligibility criteria (inclusion and exclusion) were included in this study. Groups were comparable according to demographic and baseline characteristics. The recidivism of showed a 9 times reduction and the rate of new lesson was reduced in 3.1 times. Both findings of clinical relevance. The most frequent complications were Local pain 5.7% (n=3) in the treatment group, and 14.8% (n=4) in the control group. There were not minor or major amputations reported as an outcome of treatment.
Conclusion: Combination of z-plasty lengthening of Achilles tendon plus intralesional administration of Human Recombinant Epidermal growth factor reduces the recidivism and the new lessons. This therapeutic association was considered effectiveness and safety for the prevention of the recidivism and new lessons in the neuropathic ulceration of the forefoot.

Keywords: Diabetic foot ulcer; Neuropathic ulceration; Diabetic foot surgery; Epidermal growth factor; Wound healing