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MEDICINA E CHIRURGIA DELLA CAVIGLIA E DEL PIEDE

A Journal on Physiopathology and Surgery of the Foot


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Chirurgia Del Piede 2001 March;25(1):19-26

language: Italian

Results of digital amputation and metatarsal head resection in the treatment of diabetic gangrene

Tenze L., Dell'Antonio A., Doria P., Fabiani P., Ginanneschi U., Salsano V., Tenze G.


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Background. Aim of the study was to verify the results of minor amputations in patients with diabetic foot gangrene, testing the effect of metatarsal head resection coupled with digital amputation on healing times, prevalence and persistence of plantar ulcerative lesions, to provide better deambulation and fewer post-surgery complications for these patients.
Methods. This retrospective study included 108 patients (mean age 69.7 years) with diabetic gangrene of the foot, particularly involving the toes, observed at the Department of General Surgery of the University of Trieste from January 1998 to August 2000. Patients older than 80 and/or with severe peripheral arteriopathy were not included. All patients were submitted to the necessary amputation. From this first sample (follow-up 8 months) two smaller groups were studied: group 1 included 29 patients submitted to traditional toe amputation, while group 2 included 33 patients submitted to toe amputation with resection of the metatarsal head. Average healing times in the two groups were compared (Student's ''t'' test); moreover the prevalence and persistence of plantar ulcerations in the two groups was observed.
Results. Average healing times were: 14,6 weeks for group 1 and 12,7 weeks for group 2. A signifcative T value has been calculated. Plantar ulcerations healing rate were 60 vs 67%.
Conclusions. A significative difference in healing times can lead to consider metatarsal head amputation associated with toe amputation as a useful choice, alternative to simple disarticulation in patients with diabetic gangrene.

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