Ulcer Recurrence Following First Ray Amputation in Diabetic Patients

Paola, Luca Dalla; Faglia, Ezio; Caminiti, Maurizio; Clerici, Giacomo; Ninkovic, Sasa; Deanesi, Valter

doi:10.2337/diacare.26.6.1874

Cited by 73 publications

(26 citation statements)

References 20 publications

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“…One hundred eighty‐two full‐text articles were assessed for eligibility, and 133 (65 reviews, eight studies of duplicated population, and 60 studies with data that cannot be extracted) of them were removed since they did not meet our selection criteria. Finally, 49 articles were included in our meta‐analysis after full‐text review …”

Section: Resultsmentioning

confidence: 99%

Global recurrence rates in diabetic foot ulcers: A systematic review and meta‐analysis

Ding

Miao

et al. 2019

Diabetes Metabolism Res

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Recurrence rates of diabetic foot ulcers vary widely in the published literature. The aim of this systematic review is to estimate recurrence rates of diabetic foot ulcers. We did a PubMed search and performed a review of reference lists for studies reporting recurrence of diabetic foot ulcers. The weighted relative risk (RR) and corresponding 95% confidence interval (CI) for recurrence was estimated. Forty‐nine studies reporting recurrence of diabetic foot ulcers were included. A pooled estimate for recurrence rate was 22.1% per person‐year (py) (95% CI, 19.0‐25.2%). Recurrence rate was 24.9% per py in Europe (95% CI, 20.0%‐29.7%), 17.8% per py in North America (95% CI, 12.7%‐22.9%), 16.9% per py in Africa (95% CI, 4.7%‐29.0%), and 17.0% per py in Asia (95% CI, 11.1%‐23.0%). Turkey had the highest recurrence rate of 44.4% per py (95% CI, 24.9%‐63.9%), and Bangladesh had the lowest of 4.3% per py (95% CI, 2.3%‐6.3%). Recurrence rates of diabetic foot ulcers before 2002, between 2002 and 2008, and after 2008 were 22.2% per py (95% CI, 17.6%‐26.8%), 21.9% per py (95% CI, 17.0%‐26.8%), and 21.8% per py (95% CI, 16.3%‐27.2%), respectively. Recurrence rates of diabetic foot ulcers are high. Recurrence rates vary widely in different regions and have decreased recently. More attention towards recurrence of diabetic foot ulcers is urgently required.

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Section: Resultsmentioning

confidence: 99%

Global recurrence rates in diabetic foot ulcers: A systematic review and meta‐analysis

Ding

Miao

et al. 2019

Diabetes Metabolism Res

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“…After considering all of the potentially eligible references, five (20.8%) met our inclusion criteria and were included in this study. Specifically, one evidence-based medicine level I study (4) and four level IV studies met our inclusion criteria (2, 3, 5, 6) (Table 1). The methodological quality of the included studies was generally fair, although one study was designed to be prospective with randomization of patients.…”

Section: Resultsmentioning

confidence: 99%

Incidence of re-amputation following partial first ray amputation associated with diabetes mellitus and peripheral sensory neuropathy: a systematic review.

Borkosky¹,

Roukis

2012

Diabetic Foot & Ankle

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Diabetes mellitus with peripheral sensory neuropathy frequently results in forefoot ulceration. Ulceration at the first ray level tends to be recalcitrant to local wound care modalities and off-loading techniques. If healing does occur, ulcer recurrence is common. When infection develops, partial first ray amputation in an effort to preserve maximum foot length is often performed. However, the survivorship of partial first ray amputations in this patient population and associated re-amputation rate remain unknown. Therefore, in an effort to determine the actual re-amputation rate following any form of partial first ray amputation in patients with diabetes mellitus and peripheral neuropathy, the authors conducted a systematic review. Only studies involving any form of partial first ray amputation associated with diabetes mellitus and peripheral sensory neuropathy but without critical limb ischemia were included. Our search yielded a total of 24 references with 5 (20.8%) meeting our inclusion criteria involving 435 partial first ray amputations. The weighted mean age of patients was 59 years and the weighted mean follow-up was 26 months. The initial amputation level included the proximal phalanx base 167 (38.4%) times; first metatarsal head resection 96 (22.1%) times; first metatarsal-phalangeal joint disarticulation 53 (12.2%) times; first metatarsal mid-shaft 39 (9%) times; hallux fillet flap 32 (7.4%) times; first metatarsal base 29 (6.7%) times; and partial hallux 19 (4.4%) times. The incidence of re-amputation was 19.8% (86/435). The end stage, most proximal level, following re-amputation was an additional digit 32 (37.2%) times; transmetatarsal 28 (32.6%) times; below-knee 25 (29.1%) times; and LisFranc 1 (1.2%) time. The results of our systematic review reveal that one out of every five patients undergoing any version of a partial first ray amputation will eventually require more proximal re-amputation. These results reveal that partial first ray amputation for patients with diabetes and peripheral sensory neuropathy may not represent a durable, functional, or predictable foot-sparing amputation and that a more proximal amputation, such as a balanced transmetatarsal amputation, as the index amputation may be more beneficial to the patient. However, this remains a matter for conjecture due to the limited data available and, therefore, additional prospective investigations are warranted.

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“…Titles and abstracts were screened, and 22 studies were potentially eligible for the systematic review. At the end of the screening, 21 studies [ 3 , 7 , 13 , 14 , 17 , 18 , 19 , 20 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ] met the inclusion criteria and were used in this systematic review (see Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

Metatarsal Head Resections in Diabetic Foot Patients: A Systematic Review

Sanz‐Corbalán

Tardáguila‐García

García-Alamino

et al. 2020

JCM

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A systematic review and proportional meta-analysis were carried out to investigate the complications that occur after surgical metatarsal head resection in diabetic foot patients. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist recommendations were applied, and the selected studies were evaluated using a Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist. PubMed (Medline) and Embase (Elsevier) were searched in December 2019 to find clinical trials, cohort studies, or case series assessing the efficacy of the metatarsal head resection technique in diabetic foot patients. The systematic review covered 21 studies that satisfied the inclusion criteria and included 483 subjects. The outcomes evaluated were the time to heal, recurrence, reulceration, amputation, and other complications. The proportion of recurrence was 7.2% [confidence interval (CI) 4.0–10.4, p < 0.001], that of reulceration was 20.7% (CI 11.6–29.8, p < 0.001), and that of amputation was 7.6% (CI 3.4–11.8, p < 0.001). A heterogeneity test indicated I2 = 72.6% (p < 0.001) for recurrences, I2 = 94% (p < 0.001) for reulcerations, and I2 = 79% (p < 0.001) for amputations. We conclude that metatarsal head resections in diabetic foot patients are correlated with significant complications, especially reulceration.

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Ulcer Recurrence Following First Ray Amputation in Diabetic Patients

Cited by 73 publications

References 20 publications

Global recurrence rates in diabetic foot ulcers: A systematic review and meta‐analysis

Global recurrence rates in diabetic foot ulcers: A systematic review and meta‐analysis

Incidence of re-amputation following partial first ray amputation associated with diabetes mellitus and peripheral sensory neuropathy: a systematic review.

Metatarsal Head Resections in Diabetic Foot Patients: A Systematic Review

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