Bone Marrow Exposure during Minor Amputation for Diabetic Foot Gangrene: A Single-Center Retrospective Study

The incidence of diabetic gangrene is increasing because patients are living longer with diabetes.

Data from 27 Japanese adults with diabetic foot gangrene were analyzed. All affected sites, including bones, were surgically excised. Amputation was performed at the toe or metatarsal bones, and bone marrow was adequately exposed. This retrospective review investigated the results of this therapy.

Healing was satisfactory for 26 of the 27 (96.3%) patients. Recurrence was noted in 4 (14.8%) of the 27 patients, the median number of operations was 1 (range, 1-3), and 1 (3.7%) patient required reconstructive surgery. White blood cell (WBC) count and C-reactive protein (CRP) level were significantly higher in recurrent cases than in non-recurrent cases (p = 0.009 and p = 0.001, respectively; Wilcoxon rank sum test). The cutoff values for WBC count and CRP level were 17,300/μL (specificity 100%; sensitivity 75%) and 10.23 mg/dL (specificity 81.8%; sensitivity 100%), respectively, using the Youden index. WBC count and CRP level also significantly positively associated with the number of operations (p = 0.018 and p = 0.018, respectively; Jonckheere-Terpstra trend test).

A higher WBC count and CRP level may predict recurrence and number of operations. Therapy using bone marrow exposure is simple and useful for diabetic foot gangrene. Thus, minor amputation with bone marrow exposure may be an effective treatment for diabetic foot gangrene.