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Outcomes of Diabetic Toe Amputation With Versus Without Metatarsal Head Resection for Single Ray Wet Gangrene: A
Kaissar Yammine1,2,3, Mohammad Honeine1, Joseph Mouawad1
1Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, School of Medicine, Lebanese American University, Beirut, Lebanon.
Background:
Diabetic wet gangrene of the toes is a serious condition that puts at risk the limb and life of patients. Two types of amputation are used when infection is around the metatarsophalangeal joint (MTPJ): complete toe disarticulation and toe amputation including metatarsal head resection. Because very few published papers analyzed the results of toe amputation for wet gangrene, our study aimed to evaluate the outcomes of both techniques.
Methods:
This is a retrospective comparative study of highly selective patients admitted for a single toe/ray diabetic wet gangrene that were treated with toe amputation through MTPJ (TA-MTPJ) versus toe amputation with resection of the metatarsal head (TA-MHR). Three primary outcomes were set for analysis: healing rate and the frequencies of infection recurrence and additional surgeries, including reamputations.
Results:
The sample included 31 cases: 12 cases (39%) with TA-MTPJ and 19 cases (61%) with TA-MHR. Outcomes of TA-MTPJ versus TA-MHR were as follows: (a) healing frequency 66.7% versus 58% (p = 0.6), (b) infection recurrence 50% versus 52.6% (p = 0.8), (c) osteomyelitis 41.6% versus 42.1% (p = 0.8), and (d) reamputation 33.3% versus 47.3% (p = 0.4).
Conclusions:
This study showed high complications after toe amputation for diabetic digital wet gangrene, with a trend for higher frequency of complications after TA-MHR compared to TA-MTPJ. For any type of amputation required for toe wet gangrene, it is likely that a more proximal level of index amputation is required.
Insights
Diabetic toe amputations for wet gangrene show high complication rates. Toe amputation through the metatarsophalangeal joint (TA-MTPJ) had a trend for fewer complications than toe amputation with metatarsal head resection (TA-MHR).
Area of Science:
- Podiatric surgery
- Diabetic foot complications
- Surgical outcomes research
Background:
- Diabetic wet gangrene of the toes presents a significant risk to limb and life.
- Surgical options for infection around the metatarsophalangeal joint include complete toe disarticulation or metatarsal head resection.
- Limited data exists on the comparative outcomes of these toe amputation techniques for diabetic wet gangrene.
Purpose of the Study:
- To compare the outcomes of two surgical techniques for diabetic toe wet gangrene: toe amputation through the metatarsophalangeal joint (TA-MTPJ) versus toe amputation with metatarsal head resection (TA-MHR).
- To evaluate healing rates, infection recurrence, and the need for additional surgeries, including reamputations.
Main Methods:
- Retrospective comparative study of highly selective patients with single toe/ray diabetic wet gangrene.
- Patients were treated with either TA-MTPJ or TA-MHR.
- Primary outcomes analyzed were healing rate, infection recurrence, and reamputation frequency.
Main Results:
- The study included 31 patients: 12 (39%) underwent TA-MTPJ and 19 (61%) underwent TA-MHR.
- Healing frequencies were 66.7% for TA-MTPJ and 58% for TA-MHR (p=0.6).
- Complication rates, including infection recurrence (50% vs 52.6%), osteomyelitis (41.6% vs 42.1%), and reamputation (33.3% vs 47.3%), showed no statistically significant differences between the groups.
Conclusions:
- Toe amputation for diabetic digital wet gangrene is associated with high complication rates.
- There was a trend towards a higher frequency of complications following TA-MHR compared to TA-MTPJ.
- More proximal amputation levels may be necessary for effective management of toe wet gangrene.
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