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Results of Decompression of Peripheral Nerves in Diabetics: A Prospective, Blinded Study

Aszmann, Oskar C. M.D.; Kress, Kelly M.; R, O. T.; T, C. H.; Dellon, A. Lee M.D.

Plastic and Reconstructive Surgery: September 2000 - Volume 106 - Issue 4 - p 816-822
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Diabetic neuropathy traditionally is considered progressive and irreversible and will result in lower extremity ulceration and amputation in a segment of the diabetic population, despite the best efforts to control serum glucose levels. Restoration of sensation to the diabetic may prevent these complications of neuropathy. The present study was designed to evaluate whether decompression of a peripheral nerve at a known site of anatomic narrowing can restore sensibility to that nerve in the diabetic. Twenty diabetic patients (14 type I, 6 type II, with a mean duration of diabetes of 14.8 years) had surgical decompression of a median nerve at the wrist and an ulnar nerve at the elbow, or a decompression of the posterior tibial nerve at the ankle (total of 31 nerves). A therapist, in a manner blind to the operative site, evaluated two-point discrimination in the pulp of the appropriate digit. The postoperative sensibility was compared with that of the nontreated, contralateral extremity. At a mean of 23.3 months, 69 percent of the lower-extremity nerves and 88 percent of the upper-extremity nerves (79 percent overall) had improvement in sensibility. In comparison, 32 percent of the control (not decompressed) contralateral nerves had measurable progression of neuropathy. The hypothesis that decompression of a peripheral nerve in the diabetic will improve sensibility was confirmed at the p < 0.001 level.

Vienna, Austria, and Baltimore, Md.

From the Division of Plastic Surgery at the University of Vienna, the Occupational Therapy Department at Children’s Hospital (Baltimore), and the Division of Plastic Surgery and Department of Neurosurgery at The Johns Hopkins University School of Medicine.

Received for publication September 28, 1999;

revised January 5, 2000.

A. Lee Dellon, M.D. Suite 370 3333 North Calvert Street Baltimore, Md. 21218 aldellon@erols.com

Presented at the American Society for Reconstructive Microsurgery, in Boca Raton, Florida, in 1996, and at the Plastic Surgery Research Council, in Galveston, Texas, in 1997. Presented as a poster at the American Society for Peripheral Nerve, in St. Louis, Missouri, in 1996.

A. Lee Dellon, M.D., has a proprietary interest in the quantitative sensory testing equipment, the Pressure-Specified Sensory Device, used in this study.

©2000American Society of Plastic Surgeons