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Long-term results after internal partial forefoot amputation (resection): a retrospective analysis
Madlaina Schöni1, Felix W A Waibel2, David Bauer2
1Division of Technical Orthopedics, Department of Orthopedic Surgery, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland. madlaina.schoeni@balgrist.ch.
Archives of Orthopaedic and Trauma Surgery
|April 9, 2020
Summary
Internal partial forefoot amputation (IPFA) effectively heals chronic foot ulcers. However, new ulcerations are common post-surgery, necessitating careful monitoring for recurrence or re-ulceration.
Area of Science:
- Podiatric surgery
- Diabetic foot complications
- Wound healing
Background:
- Internal partial forefoot amputation (IPFA) is a surgical option for chronic forefoot osteomyelitis and ulcers.
- Assessing IPFA's efficacy in healing, recurrence, and revision rates is crucial for treatment planning.
Purpose of the Study:
- To evaluate the healing rate of chronic ulcers after IPFA.
- To determine the incidence of ulcer recurrence or re-ulceration post-IPFA.
- To assess the revision surgery rate following IPFA for forefoot conditions.
Main Methods:
- Retrospective case series (Level IV) of 102 patients (108 feet) undergoing IPFA from 2004-2014.
- Data collected on patient characteristics, ulcer healing, new ulcer occurrence, and revisions.
- Kaplan-Meier curves used to analyze new ulcer occurrence and revision rates.
Main Results:
- 91.2% of chronic ulcers healed within a mean of 1.3 months post-IPFA.
- New ulceration occurred in 51.9% of feet, with 41.7% being re-ulcerations at new sites.
- Revision surgery was needed in 36.1% of cases; major amputation rate was low at 0.9%.
Conclusions:
- IPFA is a valuable treatment for chronic forefoot ulcers, particularly in diabetic patients.
- High rates of new ulceration (recurrence or re-ulceration) necessitate vigilant follow-up.
- The low rate of major amputations supports IPFA as a limb-sparing procedure.
