VASCULAR-SURGERY OF THE POSTERIOR TIBIAL COMPARTMENT FOR PLANTAR ULCERATION IN LEPROSY

Traditional surgical decompression of the posterior tibial nerve yield s equivocal results. The authors postulate that the posterior tibial a rtery is the most compromised structure in the neurovascular compartme nt and that the best surgical results in healing of plantar ulcers are achieved by the rechannelling of the blood flow in the posterior tibi al artery during posterior tibial neurovascular compartment surgery. T his procedure has been of benefit to patients with plantar ulcers of g reater than 7-10 years' duration in whom all other modes of healing ha d failed. It has been undertaken as an outpatient procedure under loca l anaesthesia, supported by postoperative vasodilator drugs. The use o f tourniquet, antibiotics and surgical interference with the ulcer per se was eschewed. A report of 156 patients is presented with follow-up of up to 6 years for the earlier cases.