Free tissue transfer for trophic ulcer complicating leprosy

Plantar ulceration is the most common serious disability occurring in patients of leprosy. Growth and emergence of innovative procedures in plastic surgery has greatly revolutionized the treatment of this highly frustrating problem. In the present study, a total of 40 leprosy patients were included. These ulcers were managed using different types of local superficial flaps (advancement, rotation, transposition and first toe web flap). Majority of ulcers healed within 4 weeks and patients were discharged within 6-8 weeks postoperatively. Patients were followed up for a period of 6 months to 3 years. Ulcers recurred in only 25% of all the ulcers operated upon and we observed that management of plantar ulcers by using appropriate local superficial plantar flaps is a viable option and worth trying in view of low incidence of recurrence and relatively shorter duration of hospital stay.

The great majority of diabetic patients have diabetic foot symptoms. Significant recent advances in reconstructive surgery, as well as improvements in the management of both diabetes mellitus and peripheral vascular disease, make these patients eligible for plastic and reconstructive surgery. Many diabetic patients who would previously have had below-the-knee amputations are now having their complex foot wounds reconstructed. In addition to the metabolic consequences of the disease and the increased susceptibility to infection and wound healing complications, infrapopliteal arterial occlusive disease, peripheral neuropathy, and hemorrheologic changes are addressed in this article.