University of Sassari, Italy
Emilio Trignano has completed his plastic surgery training and PhD from Sapienza University of Rome (Italy). He is a Plastic Surgery Consultant at the University of Sassari, Italy. He has published more than 30 papers in reputed journals.
Background: According to recent studies, peripheral nerve decompression in diabetic patients seems to not only improve nerve function, but also to increase microcirculation; thus decreasing the incidence of diabetic foot wounds and amputations. However, while the postoperative improvement of nerve function is demonstrated, the changes in peripheral microcirculation have not been demonstrated yet. Th e aim of this study is to assess the degree of microcirculation improvement of foot aft er the tarsal tunnel release in the diabetic patients by using transcutaneous oximetry. Patients & Methods: Twenty diabetic male patients aged between 43 and 72 years old (mean age 61.2 years old) suff ering from diabetic peripheral neuropathy with superimposed nerve compression underwent transcutaneous oximetry (PtcO2) before and aft er tarsal tunnel release by placing an electrode on the skin at the level of the dorsum of the foot. Eight lower extremities presented diabetic foot wound preoperatively. Th irty-six lower extremities underwent surgical release of the tibialis posterior nerve only, whereas four lower extremities underwent the combined release of common peroneal nerve, anterior tibialis nerve and posterior tibialis nerve. Results: Preoperative values of transcutaneous oximetry were below the critical threshold, that is, lower than 40 mm Hg (29.1±5.4 mmHg). PtcO2 values at one month after surgery (45.8±6.4 mmHg) were signifi cantly higher than the preoperative ones (P=0.01). Conclusions: Th e results of postoperative increase in PtcO2 values demonstrate that the release of the tarsal tunnel determines a relevant increase in microcirculation in the feet of diabetic patients.