Objective Evidence that Nerve Decompression Surgery Reduces Neuropathic DFU Recurrence Risk to Less Than 5.

SCOPE AND SIGNIFICANCE Care for the diabetic foot ulcer (DFU) continues to be a frustrating challenge. Standard of care (SOC) methods are plagued by regrettable levels of delayed healing, failures to heal, recurrence risk, and association with amputations and early mortality.1 We hope to bring attention to the clinical reports observing that diabetes is frequently accompanied by nerve trunk enlargement. Local sites of compression can then occur that cause neural dysfunction and pain, but respond to surgical nerve decompression (ND) and recover a degree of normal function. TRANSLATIONAL RELEVANCE Nerve compression affects autonomic function as well as sensorimotor processes. Microcirculation to the skin is under A-delta and c-fiber sympathetic control. Two microcirculation phenomena, chronic capillary ischemia (CCI) and degraded pressure induced vasodilatation (PIV), are known to be present in diabetes yet can be revived by ND. CLINICAL RELEVANCE Laboratory and clinical evidence suggest that ND is effective for improving microcirculation in these DPN patients where any other effective treatments are lacking. Clinical and pre-clinical ND studies over the past 20 years have provided a plausible and logical scientific rationale for the highly significant surgical successes in minimizing DFU complications. Recognition that ND improves neurovascular control of microcirculation offers hope of minimizing the totality of diabetic peripheral neuropathy (DPN), to the benefit of preventing DFU, DFU recurrence, and associated infection, amputation and early mortality complications. Addition of improved microcirculation to the successes of SOC is likely to allow better DPN and DFU outcomes.