Brunner's technique for open wedge resection

Abstract

The interaction of different risk factors exposes the feet of diabetics to a very high risk of infection. Therapeutic measures that are often implemented too late or are inappropriate result in major amputation. A retrospective analysis was performed to assess whether surgical reconstruction with an open wedge resection could also be achieved in cases of serious infections. An open wedge resection was performed between 1996 and 2001 on ten patients who had been suffering from diabetes mellitus for an average of 14 years. After V-shaped excision of necrotic tissue and metatarsal osteotomy close to the base, the wound was treated with wet compresses. The patients were mobilized with interim shoes or orthotics. None of the patients with an average age of 45 years experienced a recurrent ulcer or infection during the average follow-up period of 19 months. Eight patients were fitted with made-to-measure orthopedic shoes while modified standard shoes sufficed for two patients. Brunner's technique for open wedge resection is adequately radical to repair deep forefoot defects and simultaneously appropriate to avoid major amputation. The afflicted patients thus retain the highest measure of mobility and quality of life.