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[Open or closed minor amputation for diabetic gangrene?].
1Klinik für Endokrinologie, Diabetologie und Rheumatologie der Heinrich-Heine-Universität Düsseldorf. Lobnig@med.uni-duesseldorf.de
VASA. Zeitschrift Fur Gefasskrankheiten
|March 5, 2009
Summary
Closed amputations of the diabetic foot are rarely successful, especially with critical foot ischemia or osteomyelitis. Open amputations show better wound healing rates, suggesting improved diagnostic imaging may enhance closed amputation outcomes.
Area of Science:
- Vascular Surgery
- Diabetic Foot Care
- Surgical Outcomes
Context:
- Amputation below the ankle in diabetic patients often has poor outcomes.
- Minor amputations are frequently performed for diabetic foot complications.
- Assessing surgical techniques is crucial for limb salvage.
Purpose:
- To compare the outcomes of open versus closed minor amputations in diabetic patients.
- To evaluate the success rates and complications associated with each amputation type.
- To identify factors influencing wound healing and reamputation rates.
Summary:
- This study evaluated 96 minor amputations (60 toes, 48 metatarsals) in 80 diabetic patients.
- Closed amputations (n=54) had lower healing rates (26%) and higher reamputation rates (28%) compared to open amputations (n=42, 62% healing, 33% reamputation).
- Osteomyelitis was prevalent in both groups (64% closed, 78% open), significantly impacting closed amputation success (77% healing without osteomyelitis vs. 4% with).
Impact:
- Closed amputations are successful only when critical foot ischemia and osteomyelitis are absent.
- The extent of osteomyelitis is often underestimated, impacting surgical planning.
- Preoperative MRI may improve the selection and success of closed minor amputations in diabetic feet.
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