Partial Foot Amputations for Salvage of the Diabetic Lower Extremity

Boffeli, Troy J.; Thompson, Jonathan C.

doi:10.1016/j.cpm.2013.09.005

Cited by 18 publications

(27 citation statements)

References 19 publications

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“…Early distal amputation may also help minimise the need for major limb amputation as a definitive therapy [ 87 ], particularly after misguided reconstruction attempts which include significant morbidity [ 88 , 89 ].…”

Section: Choice Of Reconstruction; Alterna-tives and Adjuncts To A Flmentioning

confidence: 99%

Flap Decisions and Options in Soft Tissue Coverage of the Lower Limb

Jordan¹,

Malahias²,

Hindocha³

et al. 2014

TOORTHJ

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The lower extremities of the human body are more commonly known as the human legs, incorporating: the foot, the lower or anatomical leg, the thigh and the hip or gluteal region.The human lower limb plays a simpler role than that of the upper limb. Whereas the arm allows interaction of the surrounding environment, the legs’ primary goals are support and to allow upright ambulation. Essentially, this means that reconstruction of the leg is less complex than that required in restoring functionality of the upper limb. In terms of reconstruction, the primary goals are based on the preservation of life and limb, and the restoration of form and function. This paper aims to review current and past thoughts on reconstruction of the lower limb, discussing in particular the options in terms of soft tissue coverage.This paper does not aim to review the emergency management of open fractures, or the therapy alternatives to chronic wounds or malignancies of the lower limb, but purely assess the requirements that should be reviewed on reconstructing a defect of the lower limb.A summary of flap options are considered, with literature support, in regard to donor and recipient region, particularly as flap coverage is regarded as the cornerstone of soft tissue coverage of the lower limb.

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Section: Choice Of Reconstruction; Alterna-tives and Adjuncts To A Flmentioning

confidence: 99%

Flap Decisions and Options in Soft Tissue Coverage of the Lower Limb

Jordan¹,

Malahias²,

Hindocha³

et al. 2014

TOORTHJ

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“…Local flaps, characterised by skin without the presence of local necrosis and infection, and the transposition of neighbouring vascularised soft tissue allow coverage of a large defect . The split‐thickness skin graft may be used with meshing that allows coverage of a larger area and decreases complications, such as a seroma or haematoma . Sometimes, delayed primary closure is a valid option ; diabetic post‐amputation wounds, in fact, tend to heal often by second intention, and the main disadvantage is the high complication rates in wound healing that range from approximately 40% to 70% .…”

Section: Resultsmentioning

confidence: 99%

“…After performing a TMA, wound closure is a pivotal element that must be tailored according to the wound's and the patient's conditions, and when appropriate, adjuvant local treatments must be considered (skin grafting, NPWT, application of PG) in order to speed up and maintain wound healing (58)(59)(60)(66)(67)(68)71).…”

Section: Discussionmentioning

confidence: 99%

The care of transmetatarsal amputation in diabetic foot gangrene

Ammendola

Sacco

Butrico

et al. 2016

International Wound Journal

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Diabetic foot ulcerations may determine minor or major amputation, with a high impact on patients' life expectation and quality of life and on economic burden. Among minor amputations, transmetatarsal amputation (TMA) appears to be the most effective in terms of limb salvage rates and in maintaining foot and ankle biomechanics. In spite of this, TMA needs particular pre- and postoperative management in order to avoid the frequent failure rates. A systematic review was undertaken of studies concerning TMA and its care in diabetic foot gangrene. Studies were identified by searching the MEDLINE, Scopus and Science Direct databases until 13 January 2016. All studies were assessed using the Downs and Black quality checklist. Of the 348 records found, 86 matched our inclusion criteria. After reading the full-text articles, we decided to exclude 35 manuscripts because of the following reasons: (1) no innovative or important content, (2) no multivariable analysis, (3) insufficient data, (4) no clear potential biases or strategies to solve them, (5) no clear endpoints and (6) inconsistent or arbitrary conclusions. The final set included 51 articles. In the current literature, there are less data about TMA, indication for the selection of patients, outcomes and complications. Generally, the judgment of an experienced physician is one of the best indicators of subsequent healing. Ankle brachial indices, toe pressures, laser Doppler skin perfusion pressures, angiography and Doppler assessment of foot vasculature may help physicians in this decision. In any case, despite the presumed lower healing rate, it is reasonable to pursue a TMA in a patient with a higher likelihood of continued ambulation. Furthermore, tailored wound closure, adjuvant local treatments and the choice of the most appropriate antibiotic therapy, when infection occurs, are pivotal elements for the success of TMA procedures. TMA is a valuable option for diabetic foot gangrene that can prevent major limb loss and minimise loss of function, thus improving the quality of life for diabetic patients.

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“…Statistics have shown that, out of the 80,000 amputations performed in the USA per annum, approximately half of these belong to below-knee or more proximal amputations [35]. The estimated 1-year mortality rate after a below-knee amputation ranges between 20.8% and 35.5% [36], with a reported contralateral limb loss rate of 53.3% within 5 years [37]. Research has deduced that proximal amputations result in decreased ambulatory status due to inefficient biomechanics, hence when possible, partial foot amputation is recommended that will reduce morbidity and will help restore biomechanics esp.…”

Section: Discussionmentioning

confidence: 99%