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Table 2 Literature Review – Study Characteristics

From: Effectiveness of percutaneous flexor tenotomies for the management and prevention of recurrence of diabetic toe ulcers: a systematic review

  Kearney et al. [23] Laborde [17] Rasmussen et al. [15] Tamir et al. [24] Van Netten et al. [25]
Patients (No.) 48 14 16 55 30
Procedures (No.) 58 24 27 103 38
Age range (Years) • Mean 68.1 ± 2.3 • 40–81 • 37–91 • 48–89 • 42-93
• Mean 55 • Mean 62.8 • Mean 65 • Mean 69 ± 12
Gender • M:11, F:37 • M: 7 F: 11 • Insufficiently reported: prophylactic and ulcerated patients reported together • Not reported • M: 17, F:16
Diabetes duration • Not reported • Not reported • Insufficiently reported: prophylactic and ulcerated patients reported together • Insufficiently reported – patients receiving different interventions reported together • Not reported
HbA1C • 7.3 ± 1.4 • Not reported • Insufficiently reported: prophylactic and ulcerated patients reported together • Insufficiently reported – patients receiving different interventions reported together • Not reported
Inclusion criteria • Diabetes • Not reported • Not reported • Not reported • Not reported
• Distal toe ulceration
Exclusion criteria • Healed ulcer • Grade 4/5 ulcersb • Not reported • ABPI below 0.5/flat pulse volume at ankle • Not reported
• Adjunct procedures
• Cellulitis
Pre-selection assessments (% of patients with condition) • Neuropathy: mono-filament/biothesiometer (100 %) • Neuropathy: mono-filament (100 %) • Neuropathy: monofilament/biothesiometer (100 %) • Neuropathy: Assessment and patient characteristics not reported. • Neuropathy: monofilament (100 %)
• Poor vascular status: absent pulses (14 %) • PAD: absent pulses/Doppler (0 %)
• PAD: absent pulses (36.2 %)
• Poor arterial perfusion: Pulses/ankle blood pressure (18 %)
• Vascular status: ABPI (% not reported)
Ulcer grades –No. (% of ulcers) • Not reported • 1b – 11 (46 %) • 1a – 23 (85 %) • 0a – 25 (24 %) • 1a – 20 (53 %)
• 2b – 5 (21 %) • 2a – 1 (4 %) • 1a – 73 (71 %) • 2a – 0 (0 %)
• 3b – 8 (33 %) • 3a – 3 (11 %) • 2/3a – 5 (5 %) • 3a – 18 (47 %)
Ulcer duration • Not reported • 1 month – 5 years • Range 1–48 weeks • Range: 1 – 156 Weeks • 9 – 525 days
• Mean: 96 days
• Average: 10 months • Median: 15 weeks • Mean: 33 weeks
Digit tenotomised • Not specified – only FDL transected, therefore assumed to be digits 2-5 • Hallux – 14 • Hallux – 15 • Hallux – 16 • Hallux – 12
• 2 – 7 • 2 – 10 • 2 – 31 • 2 – 15
• 3 – 2 • 3 – 2 • 3 – 37 • 3 – 11
• 4 – 0 • 4 – 0 • 4 – 16 • 4 – 0
• 5 – 1 • 5 – 0 • 5 – 3 • 5 – 0
Incision location Distal phalanx Proximal portion of proximal phalanx 1 cm proximal to the web fold Mid-portion of proximal phalanx Mid-portion of proximal phalanx
Tendons transected • FDL – 58 toes • FDL & FDB – • FDL & FDB – • FDL – 87 Toes • FDL – 26 Toes
• 10toe • 12 Toes • FHL – 16 Toes • FHL – 12 Toes
• FHL – 14 Toes • FHL & FHB – 15 Toes
Post-op offloading • Immediate weightbearing • Full weightbearing • 2–3 days post-op hosp. immobilization • Not reported • 24 h offloading plus pressure bandage
• Post-op shoes/sandals/extra depth shoe
• Rigid soled sandals
• Rocker bottom sandals + soft insoles
Return appointment Not reported 3–5 days then weekly until healed 1 weeks then as required until healed 1 week then regularly until healed 1 week then regularly
Follow-up period (months) • Mean: 28 • 20–64 • 2–48 • Minimum: 5 • 11–60
• Mean: 23 ± 11
• Interquartile range:16–29
• Median: 22
• Average: 36 • Median: 31
  1. KEY: No. Number, ABPI Ankle Brachial Pressure Index, PAD Peripheral Arterial Disease, FDL Flexor Digitorum Longus, FDB Flexor Digitorum Brevis, FHL Flexor Hallucis Longus, FHB Flexor Hallucis Brevis, aUlcer Grades on Texas Scale [26], bUlcer grades on Wagner’s Scale [26]
  2. NOTE: Data reported in the original studies on non-diabetic patients [17], non-Flexor Tenotomy procedures [24] and prophylactic procedures [15, 25] have been omitted from this table due to irrelevance to the research question