The management of neuropathic ulcers by the application of constant tension: a preliminary report
R. GER FRCS(Eng) FRCS(Edin)
Department of Surgery, Nassau County Medical Centre, New York, USA

Summary
A preliminary report of a clinical trial is presented where a series of subacute and chronic neuropathic ulcers have been treated by the application of a device that, by subjecting the wound margins to a constant low grade force over days to weeks, both approximates the edges of the lesion and encourages the generation of tissue and skin.
Minimally Invasive Therapy 1995 4: 179-182

Introduction
Ulceration of the foot is common in patients suffering from neuropathy.  Diabetes is the commonest cause of neuropathy and is associated with minor or major amputations. Five of six major amputations involve the diabetic patient [1].    Healing of these foot ulcers may be attained by conservative means, which usually means by secondary intention, and, if unsuccessful, by operative procedures.  The latter vary from relatively simple approaches such as split thickness skin grafts to more complicated procedures such as advancement and rotation flaps [2,3], and muscle transposition procedures [4].  Vascular reconstructive procedures may also be a necessary accompaniment to the more demanding operative approaches. As in most surgical conditions, the more demanding and difficult the situation the higher the morbidity and mortality.

Recurrent ulceration is likewise a significant problem that has similar end results to those mentioned above. The causes of recurrence are varied and include general and local conditions.  Amongst the former are persistence of the underlying condition and, in diabetic patients, complications, especially those resulting from angiopathy. Local conditions include persistence of bony abnormalities such as deformities leading to abnormal pressure points, chronic osteomyelitis and the healing of lesions by secondary intention. Recurrence following the latter mechanism is often traced to the fragile epithelial covering that is unable to withstand the pressures of daily living, especially when situated in weight bearing areas such as the sole of the foot.

Because of the above problems, a device was designed and constructed (Proxiderm, Progressive Surgical Products, Westbury, New York) that would, by conservative and non-operative methods, encourage healing by full thickness skin by a combination of skin stretching and generation. This paper covers the preliminary results obtained with the use of the device in the treatment of 13 diabetic and five neuropathic patients with foot lesions.

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