Impact of the Timing of Foot Tissue Resection on Outcomes in Patients Undergoing Revascularization for Chronic Limb-Threatening Ischemia

Abstract

The objective of this study is to describe utilization of revascularization and tissue resection in patients with chronic limb-threatening ischemia (CLTI) and determine whether the timing of resection impacts outcomes. Revascularizations for CLTI were queried (ACS-NSQIP 2011-2015). Outcomes included 30-day major adverse limb events (MALE), major adverse cardiac events (MACE), length of stay (LOS), operative time, 30-day readmissions, and wound infections. Groups included revascularization alone, revascularization/tissue resection during the same procedure (concurrent), or revascularization/delayed tissue resection (delayed). Resections were debridement or transmetatarsal amputations. Multivariate logistic regression determined risk-adjusted effects of tissue resection on outcomes. There was no difference in overall 30-day MACE or MALE between groups ( P = .70 and P = .35, respectively). Length of stay (6.1 days revascularization alone vs 7.8 days concurrent vs 8.7 days delayed, P < .0001) was longer in patients who underwent any tissue resection. Highest 30-day readmission and operative time was the concurrent group ( P = .02 and P < .0001, respectively). Wound infection was highest in the delayed group (1.4% revascularization alone vs 1.3% concurrent vs 6.2% delayed, P < .0001). After risk adjustment, timing of resection did not impact LOS for concurrent and delayed groups compared to revascularization alone (both P < .0001). Debridement and minor amputations can be done concurrently in patients undergoing revascularization for CLTI.

Efficacy of Early Closed Toe Amputation for Toe Ulcers with Suspected Osteomyelitis after Revascularization for Chronic Limb-Threatening Ischemia

“…Some authors advocate early primary closure or concurrent foot tissue resection (including debridement and minor amputations) after revascularization for CLTI. 11 , 12 ) We have focused on the wound management of toe ulcers after revascularization for CLTI. Our study showed that better wound healing after revascularization was achieved by early closed toe amputation for suspected osteomyelitis compared with conservative treatment.…”

“… 9 , 10 ) However, there is a paucity of evidence of primary closure of toe amputation for foot lesions associated with CLTI. 11 , 12 ) Fourth, higher levels of amputation such as transmetatarsal amputation (TMA) or BK amputation may achieve better healing rates than toe amputation for foot lesions associated with CLTI, but these could also result in loss of walking ability. In a previous study, it was found that the ability to walk was maintained by 98% of patients with CLTI who underwent toe amputation compared with 86% of those who underwent TMA and 33% of those who underwent BK amputation.…”