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Association of revascularization strategy with wound healing following toe amputation in chronic limb-threatening

Shun Kurose1, Koichi Morisaki2, Daisuke Matsuda1

  • 1Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan.

Journal of Vascular Surgery
|July 3, 2026
PubMed

Insights

Bypass surgery improved wound healing after toe amputation for chronic limb-threatening ischemia (CLTI). The number of toes amputated influenced outcomes, with bypass showing better results, especially in single-toe amputations.

Area of Science:

  • Vascular Surgery
  • Wound Healing Research
  • Ischemia Management

Background:

  • Chronic limb-threatening ischemia (CLTI) frequently necessitates toe amputation.
  • Current wound grading systems inadequately capture tissue loss extent.
  • Outcomes vary based on revascularization strategy and amputation extent.

Purpose of the Study:

  • Compare wound healing after toe amputation following endovascular therapy (EVT) versus bypass surgery.
  • Stratify outcomes by the number of toes amputated.
  • Identify predictors of wound healing in CLTI patients.

Main Methods:

  • Retrospective multicenter cohort study (2015-2023) of CLTI patients undergoing infrainguinal revascularization and toe amputation.
  • Patients classified into single- and multiple-toe amputation cohorts.
  • Wound healing assessed using cumulative incidence functions; competing risks analysis for death/major amputation; inverse probability of treatment weighting for comparisons.

Main Results:

  • Bypass surgery showed faster wound healing in single-toe amputations (84.4% vs. 72.7% at 1 year).
  • Bypass trended towards better 1-year healing (73.6% vs. 53.4%) and limb salvage in multiple-toe amputations.
  • Bypass surgery independently predicted wound healing; hemodialysis, inframalleolar disease, and tissue loss severity predicted delayed healing.

Conclusions:

  • Bypass surgery is associated with superior wound healing post-toe amputation.
  • The extent of tissue loss (number of toes amputated) is critical for evaluating revascularization outcomes.
  • Consider amputation extent when choosing revascularization strategies for CLTI.
Abstract

Keywords:
Bypass surgeryChronic limb-threatening ischemiaEndovascular therapyToe amputationWound healing

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