Das behandlungskonzept nach dellon bei patienten mit peripherer neuropathie und chronischer nervenkompression

Translated title of the contribution: The dellon approach to neurolysis in the neuropathy patient with chronic nerve compression

Research output: Contribution to journalReview articlepeer-review

Abstract

Impaired glucose tolerance creates a peripheral nervous system that is susceptible to chronic nerve compression. While it is accepted that surgical decompression of the median nerve at the wrist, for carpal tunnel syndrome, is appropriate in the diabetic, application of this concept to the lower extremity has not yet gained widespread recognition. Traditional electrodiagnostic studies demonstrate the presence of neuropathy, but usually are much less able to demonstrate superimposed nerve compression in the lower extremity in the presence of neuropathy. The clinician must rely upon the presence of a positive Hoffmann-Tinel sign to identify the patient with diabetic neuropathy and nerve compression. Combining sensory territories of common peroneal and tibial nerves gives a stocking pattern of sensory impairment. A positive Hoffmann-Tinel sign over the tibial nerve in the tarsal tunnel has a 90% positive predictive value for the diabetic patient to recover sensibility in the foot after decompression of the four medial ankle tunnels. A meta-analysis of clinical studies that have decompressed the tibial nerve branches at the ankle in diabetics with neuropathy and tibial nerve compression demonstrate pain relief in 80% of the patients from a mean of 8.5 on the VAS to 2.0, and demonstrate 80% of the patients recover more than just protective sensation. With sensibility partially restored, ulceration and subsequent amputation can be prevented. Balance can recover, and with it, morbidity from falls/fracture can be prevented. Hospitalization for foot infection can be reduced. This review includes description of the surgical approaches to accomplish these outcomes.

Translated title of the contributionThe dellon approach to neurolysis in the neuropathy patient with chronic nerve compression
Original languageGerman
Pages (from-to)351-360
Number of pages10
JournalHandchirurgie Mikrochirurgie Plastische Chirurgie
Volume40
Issue number6
DOIs
StatePublished - Dec 2008

Keywords

  • Below-knee reconstruction
  • Foot
  • Interdisciplinary plastic surgery
  • Lower leg
  • Nerve compression syndrome

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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