Clinical outcomes after closed, staged, and open forefoot amputations

Area of Science:

• Orthopedic Surgery
• Infectious Disease Management
• Limb Salvage Procedures

Background:

• Forefoot osteomyelitis presents surgical challenges, with options including immediate closure, staged procedures, or open wound care.
• Evaluating the effectiveness of different amputation techniques is crucial for preventing major leg amputation and preserving limb function.

Purpose of the Study:

• To assess the efficacy of closed, staged, and open forefoot amputations in preventing major leg amputation.
• To identify factors associated with successful limb preservation in patients with forefoot osteomyelitis.

Main Methods:

• A prospective study from 2002-2004 included 208 patients with forefoot osteomyelitis or gangrene undergoing minor amputation.
• Patients were categorized into CLOSED (immediate closure), STAGED (delayed closure), and OPEN (no initial closure) groups based on infection severity.
• Data collected included demographics, need for re-operation, healing time, and progression to major amputation.

Main Results:

• Of 204 patients, OPEN amputations showed lower initial healing (37%) and higher re-operation rates (43%) but achieved 70% limb salvage.
• CLOSED (71%) and STAGED (78%) groups had similar initial healing and high early limb salvage (86% and 91%).
• Median healing times were 1.2 months (CLOSED), 1.6 months (STAGED), and 4.6 months (OPEN); however, long-term follow-up revealed similar major amputation rates (30-35%) across all groups.

Conclusions:

• Open forefoot amputation, despite challenges, offers limb salvage comparable to less invasive methods for severe infections.
• Staged closure improves healing time without increasing major amputation risk.
• Regardless of the initial surgical approach, a significant proportion of patients with forefoot osteomyelitis ultimately require major leg amputation.