Bedside amputation surgery for isolated toe necrosis in diabetes units as an alternative to conventional amputation in surgery units.

AIM: Toe necrosis is a common complication of diabetic foot ulcer (DFU). Amputation surgery is usually performed by a surgeon in the operating room. In response to the limited availability of operating rooms, clinicians from two specialized diabetic foot units performed bedside surgery to amputate isolated toe-necrosis-complicated DFU. The aim of our study was to compare the rate of wound healing 6 months after toe amputation following bedside amputation surgery (BAS) and conventional amputation surgery (CAS).

METHODS

This retrospective observational multi-center study was conducted in two French diabetic foot units. All patients with diabetes mellitus (DM) who underwent a toe amputation for isolated necrosis in an operating room (CAS) or at bedside (BAS) were included (05/2016 - 07/2023). The primary endpoint was the 6-month healing rate, defined as a complete skin epithelialization without recurrence at 6 months, without secondary amputation.

RESULTS

Out of 2029 patients admitted for DFU, 189 had isolated toe necrosis requiring limited amputation (9%). Among the 171 patients who attended follow-up at 6 months: males 82.5%, type 2 DM 94.7%, average duration of DM 18.3 ± 0.9years, average HbA1c 8.6 ± 2%. BAS was performed on 106/171(62%) patients. The 6-month healing rate was not significantly different between the two groups (BAS 53.8% vs CAS 52.3%, P = 0.852). The rate of secondary surgery was not significantly different (BAS 24.5% vs CAS 16.9%, P = 0.241).

CONCLUSION

BAS is a safe and efficient approach for the treatment of isolated toe necrosis, resulting in a healing rate similar to that of conventional surgery.