TY - JOUR
T1 - The positive effect of neurolysis on diabetic patients with compressed nerves of the lower extremities
T2 - A systematic review and meta-Analysis
AU - Baltodano, Pablo A.
AU - Basdag, Basak
AU - Bailey, Christopher R.
AU - Baez, Marcelo J.Lacayo
AU - Tong, Anne
AU - Seal, Stella M.
AU - Meléndez, Mark M.
AU - Xie, Li
AU - Manahan, Michele A.
AU - Rosson, Gedge D.
N1 - Publisher Copyright:
Copyright © 2013 American Society of Plastic Surgeons.
PY - 2013/7/2
Y1 - 2013/7/2
N2 - Background: Despite proven benefits of upper extremity nerve decompression in diabetics, neurolysis for diabetic patients with lower extremity (LE) nerve compression remains controversial. Methods: A search of ClinicalTrials.gov and Cochrane clinical trials registries, CENTRAL (The Cochrane Library), MEDLINE, EMBASE, LILACS, CINAHL, SCOPUS, and Google Scholar from 1962 to 2012, yielded 1958 citations. Any potential randomized or quasi-randomized controlled trials and observational cohort studies of diabetics with neurolysis of the common peroneal nerve, deep peroneal nerve, or tibial nerve were assessed. We included articles in any language that 1) provided information about diabetic patients who had neurolysis for symptomatic nerve compression diagnosed by (+) Tinel sign or electrodiagnostic study, and 2) quantified outcomes for pain, sensibility, or ulcerations/amputations. Case reports, review articles, animal or cadaver studies, and studies with <10 patients were excluded. We assessed pain relief, recovery of sensibility, and postoperative incidence of ulcerations/amputations at follow-up >3 months. A meta-Analysis of descriptive statistics was performed. Results: Ten clinical series with a mean clinical relevance score of 70% and a mean methodologic quality score of 50% met inclusion criteria. We included 875 diabetic patients and 1053 LEs. Pain relief >4 points on visual analog scale occurred in 91% of patients; sensibility improved in 69%. Postoperative ulceration/amputation incidence was significantly reduced compared to preoperative incidence (odds ratio = 0.066, 95% confidence interval = 0.026-0.164, P < 0.0001). Conclusions: Observational data suggest that neurolysis significantly improves outcomes for diabetic patients with compressed nerves of the LE. No randomized controlled trials have been published.
AB - Background: Despite proven benefits of upper extremity nerve decompression in diabetics, neurolysis for diabetic patients with lower extremity (LE) nerve compression remains controversial. Methods: A search of ClinicalTrials.gov and Cochrane clinical trials registries, CENTRAL (The Cochrane Library), MEDLINE, EMBASE, LILACS, CINAHL, SCOPUS, and Google Scholar from 1962 to 2012, yielded 1958 citations. Any potential randomized or quasi-randomized controlled trials and observational cohort studies of diabetics with neurolysis of the common peroneal nerve, deep peroneal nerve, or tibial nerve were assessed. We included articles in any language that 1) provided information about diabetic patients who had neurolysis for symptomatic nerve compression diagnosed by (+) Tinel sign or electrodiagnostic study, and 2) quantified outcomes for pain, sensibility, or ulcerations/amputations. Case reports, review articles, animal or cadaver studies, and studies with <10 patients were excluded. We assessed pain relief, recovery of sensibility, and postoperative incidence of ulcerations/amputations at follow-up >3 months. A meta-Analysis of descriptive statistics was performed. Results: Ten clinical series with a mean clinical relevance score of 70% and a mean methodologic quality score of 50% met inclusion criteria. We included 875 diabetic patients and 1053 LEs. Pain relief >4 points on visual analog scale occurred in 91% of patients; sensibility improved in 69%. Postoperative ulceration/amputation incidence was significantly reduced compared to preoperative incidence (odds ratio = 0.066, 95% confidence interval = 0.026-0.164, P < 0.0001). Conclusions: Observational data suggest that neurolysis significantly improves outcomes for diabetic patients with compressed nerves of the LE. No randomized controlled trials have been published.
UR - http://www.scopus.com/inward/record.url?scp=84879541282&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84879541282&partnerID=8YFLogxK
U2 - 10.1097/GOX.0b013e318299d02b
DO - 10.1097/GOX.0b013e318299d02b
M3 - Review article
C2 - 25289218
AN - SCOPUS:84879541282
SN - 0032-1052
VL - 1
JO - Plastic and reconstructive surgery
JF - Plastic and reconstructive surgery
IS - 4
M1 - e24
ER -