Comparing Clinical Outcomes after Toe Amputation and Toe-Sparing Surgery in Patients with Diabetic Foot Ulcer.

BACKGROUND

Diabetic ulceration leads to amputation in up to 85% of cases. Managing a diabetic ulcer requires an expert team to prevent wound progression and apply proper supportive procedures, decreasing the risk of amputation. This study aimed to compare the clinical efficacy of toe-sparing surgery and toe amputation in patients with diabetic foot ulcers.

METHODS

This cohort evaluated 54 consecutive patients with Diabetes Mellitus and chronic ulcers in the lower extremities. The patients were treated by bone resection with preserving toe and soft tissue or complete toe amputation. They were followed up for one year. We evaluated the relative risk for re-ulceration of the same toe, ulcers in other parts, increased levels of hemoglobin A1c (HbA1c), and infection between the two groups.

RESULTS

The re-ulceration rate at the same toe was 12.9% in the toe amputation and 39.1% in the toe-sparing group (P < 0.001). The prevalence of other amputations in the toe amputation and toe-sparing surgery groups was 29.0% and 17.4%, respectively (P < 0.001). However, the infection rate was lower in the toe-sparing group (P < 0.001).

CONCLUSION

The re-ulceration rate was lower after toe amputation, and the infection rate was higher in the toe amputation group.