Surgical Treatment of Intractable Plantar Warts
The majority of plantar warts are successfully eradicated by conservative measures such as escharotic solutions, electro-desiccation, or irradiation in the form of x-ray. Comparable results are obtained by each of the above methods, 60 per cent to 90 per cent cures. Escharotics are reserved for simple cases, and electro-desiccation and irradiation are employed when local application of these substances fails. If a single method is desired, the selection would undoubtedly be x-ray, for this treatment is painless, short, successful, and safe, provided the treatment is administered with due respect to the tolerance dose.
It is recognized, however, that no matter how skillfully used, these methods fail in at least 10 per cent of cases. These intractable problems are not only distressing but often calamitous to the patient. After many years of therapy extremely painful ulceration on the plantar surface of the foot may still persist. This ulcer invariably extends through the deep fascia, and the dermatologist and roentgenologist feel thay have run the gamut and that further cautery, x-ray or radium treatment is contra-indicated. For this type of plantar wart the only recourse is removal of the wart area in its entirety, and while this in itself presents no difficulty, the restoration of the operative site to a painless weight-bearing area involves many surgical problems. The amount of tissue removed may make immediate closure impossible, and even though approximation of the skin edges can be accomplished, it is performed under such tension that the resulting scar becomes thick, unyielding, and. . .