Incidence of Repeat Amputation after Partial First Ray Amputation Associated with Diabetes Mellitus and Peripheral Neuropathy: An 11-Year Review

Borkosky, Sara L.; Roukis, Thomas S.

doi:10.1053/j.jfas.2013.02.004

Cited by 33 publications

(20 citation statements)

References 24 publications

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“…It has been reported that patients with diabetes and peripheral neuropathy who undergo a partial first ray amputation show a high rate of progression to a more proximal repeat amputation, despite initial healing. 14,15 Our results are consistent with these reports. Two possible mechanisms, one based on the angiosome and the other based on anatomy, may explain these results.…”

Section: Discussionsupporting

confidence: 93%

Great Toe Necrosis Predicts an Unfavorable Limb Salvage Prognosis

Sano¹,

Ichioka

2014

Plastic and Reconstructive Surgery Global Open

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Summary:The initial location of necrosis may affect the limb salvage rate. This study of 130 patients with chronic toe ulcers or gangrene was performed to assess whether the location of initial necrosis in the toes affected limb salvage prognosis. The patients were divided into 2 groups according to whether the initial necrosis was in the great toe or in other toes. Limb salvage prognosis was determined retrospectively. In the great toe group, the rates of total toe loss and major amputation were 50.0% and 24.4%, respectively. When the initial necrosis was in other toes, these rates were 27.3% and 9.3%, respectively. Great toe necrosis is associated with significantly higher rates of total toe loss (odds ratio = 3.10; P = 0.003; 95% confidence interval, 1.43−6.68) and major amputation (odds ratio = 3.66; P = 0.007; 95% confidence interval, 1.37−9.79). The great toe is supplied by 3 source arteries, whereas the lesser toes are fed by 1 or 2 arteries. Therefore, necrosis initiating from the great toe may reflect the presence of severe vascular disorders. The great toe is also anatomically connected to much of the foot via the tendons. Infection is more likely to spread along these tendons, which may reduce limb prognosis. Thus, the initial location of necrosis may be predictive of limb prognosis.

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Section: Discussionsupporting

confidence: 93%

Great Toe Necrosis Predicts an Unfavorable Limb Salvage Prognosis

Sano¹,

Ichioka

2014

Plastic and Reconstructive Surgery Global Open

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“…16 For the same reasons, multiple other studies have concluded that digital amputation is neither reliable nor durable. 13,18 Outcomes of TMAs seem to be more consistent in the literature. Tracy et al 19 reported a 70% healing rate after TMA and a 4.8% hospital mortality rate.…”

Section: Discussionsupporting

confidence: 68%

Quality of time spent without symptoms of disease or toxicity of treatment for transmetatarsal amputation versus digital amputation in diabetic patients with digital gangrene

et al. 2017

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Aim We aim to compare the outcome of diabetic patients with gangrenous toes who were managed initially either by digital amputation or by transmetatarsal amputation. The null hypothesis is that transmetatarsal amputation had less theatre trips and better healing. Materials and Methods A parallel observational comparative study of all diabetic patients who underwent either digital or transmetatarsal amputation in a tertiary referral center from 2002 through 2015. Comorbid conditions, subsequent amputations, hospital stay, and readmission were noted. Results A total of 223 patients underwent minor amputation during the study period, of which 147 patients were diabetic and 76 patients were non-diabetic. Seventy-seven patients had digital amputation and 70 transmetatarsal amputation in diabetic patients. Demographics were similar in both groups. The median time to major amputation was (400 ± IQR 1205 days) in the digital amputation group, compared to 690 ± IQR 891 days in the transmetatarsal amputation group ( P = 0.974). 29.9% of digital amputations and 15.7% of transmetatarsal amputations in diabetic patients, required minor amputations or revision procedures ( P = 0.04). Median length of hospital stay was (20 days, IQR 27) in the digital group and (17 days, IQR17) in the transmetatarsal amputation group ( P = 0.17). Need for re-admission was 48.1% in digital patients compared to 50% in transmetatarsal amputation patients ( P = 0.81). Quality of time spent without symptoms of disease or toxicity of treatment (Q-TWiST) was (315 days, IQR 45) in digital group and (346 days, IQR 48) in the transmetatarsal amputation patients ( P = 0.099). Conclusion Despite the lack of statistical significance, transmetatarsal amputation offered better outcome in the diabetic patients, with less re-intervention rate, shorter hospital stays, less theatre trips, and longer time without toxicity (TWiST).

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“…Although FRA seems to affect gait less than a more proximal amputation, at least with respect to asymmetry of the gait, published studies have reported that patients who undergo partial FRA often progress to requiring a more proximal repeat amputation (37). We believe that the risk of new ulceration, resulting in a new amputation, will be greater for those undergoing FRA rather than a more proximal amputation owing to the better weightbearing with the latter.…”

Section: Discussionmentioning

confidence: 82%

Does First Ray Amputation in Diabetic Patients Influence Gait and Quality of Life?

Aprile

Galli²,

Pitocco

et al. 2018

The Journal of Foot and Ankle Surgery

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It has recently been suggested that first ray amputation in diabetic patients with serious foot complications can prolong bipedal ambulatory status, and reduce morbidity and mortality. However, no data are available on gait analysis and quality of life after this procedure. In the present case-control study (6 amputee and 6 nonamputee diabetics, 6 healthy non-diabetic), a sample of amputee diabetic patients were evaluated and compared with a sample of nonamputee diabetic patients and a group of age-matched healthy subjects. Gait biomechanics, quality of life, and pain were evaluated. Compared with the other 2 groups, amputee patients displayed a lower walking speed and greater variability and lower ankle, knee, and hip range of motion values. They also tended to have a more flexed hip profile. Pain and lower quality of life were related to worsening biomechanical data. Our study results have shown that gait biomechanics in diabetic patients with first ray amputation are abnormal, probably owing to the severity of diabetes and the absence of the push-off phase provided by the hallux. Tailored orthotics and rehabilitation programs and a specific pain management program should be considered to improve the gait and quality of life of diabetic patients with first ray amputation.

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Incidence of Repeat Amputation after Partial First Ray Amputation Associated with Diabetes Mellitus and Peripheral Neuropathy: An 11-Year Review

Cited by 33 publications

References 24 publications

Great Toe Necrosis Predicts an Unfavorable Limb Salvage Prognosis

Great Toe Necrosis Predicts an Unfavorable Limb Salvage Prognosis

Quality of time spent without symptoms of disease or toxicity of treatment for transmetatarsal amputation versus digital amputation in diabetic patients with digital gangrene

Does First Ray Amputation in Diabetic Patients Influence Gait and Quality of Life?

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