Factors influencing the healing of distal amputations performed for lower limb ischaemia

Abstract

A total of 235 toes were amputated during 125 operations on 100 consecutive patients with lower limb ischaemia. The overall amputation wound healing rate for the series was 58.4 per cent and limb salvage was achieved in 66 patients. Toe amputation was performed under local anaesthesia in 57 cases and 32 (56 per cent) of these healed primarily, not significantly different from the healing rate of 41 (60 per cent) of 68 under general anaesthesia. Reconstructive arterial surgery was performed in conjunction with toe amputation in 39 patients; the healing rate with reconstruction was 32 (82 per cent) of 39, significantly better than the 41 (48 per cent) of 86 patients not undergoing bypass surgery (P less than 0.001). There was no difference in healing rates when comparing diabetic and non-diabetic patients. Multiple regression analysis demonstrated that reconstructive arterial surgery was the only factor which had an independent and significant influence on toe amputation healing. The use of local anaesthesia for distal amputation has no deleterious effects on wound healing.

Outcomes of minor amputations in patients with peripheral vascular disease over a 10-year period at a tertiary care institution

“…Other studies have shown similar wound healing rates between diabetics and non-diabetics. [5][6][7]14 In our study, diabetes was not predictive of poor outcomes, though the study cohort consisted of few non-diabetic patients and lacked data on HbA1c glucose control.…”

“…Diabetic and non-diabetic populations were included since they have been reported to have similar healing rates after minor amputations. [5][6][7] Secondary objectives included examining clinical and haemodynamic factors that predict healing and conversion to major amputation.…”

Diabetic Foot Ulcer

“…[60,61] Once hallux has gone under amputation, changes in mechanical force and pressure on the foot may increase the likelihood of developing further lesions, most probably within 6 months. [62] Studies by Byrne et al 1992 andYeager et al 1998 showed that revascularization may not prevent reamputation as patients undergoing revascularization procedures are likely to have severe ischaemic disease. [63,64]…”

“…[62] Studies by Byrne et al 1992 andYeager et al 1998 showed that revascularization may not prevent reamputation as patients undergoing revascularization procedures are likely to have severe ischaemic disease. [63,64]…”

Risk of Ipsilateral Reamputation Following an Incident Toe Amputation Among U.S. Military Veterans With Diabetes, 2005–2016

“…Dillingham et al (10) estimated that .37% of patients with diabetes who had a toe amputation in 1996 had a second LEA within 12 months, proportions that exceeded reamputation rates following a transtibial (25%) or a transfemoral (18%) amputation. Although there are more than a dozen studies that have assessed risks of subsequent amputations among patients who underwent toe or ray (a more extensive toe amputation that involves excision of the metatarsal head) amputation(s) (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), most prior studies were small; only four studies included .200 patients (10,15,20,22), and of these, the one by Dillingham et al (10) was the largest with 889 U.S. Medicare beneficiaries. One important limitation of this study was the inability to distinguish subsequent amputations on the ipsilateral limb from amputations on the contralateral limb because information on laterality was not available.…”