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-
1
Dillon MP, Barker TM: Preservation of residual foot length in partial foot amputation: a biomechanical analysis. Foot Ankle Int 27: 110, 2006.
-
2
Centers for Disease Control and Prevention: National Diabetes Statistics Report 2020: Estimates of Diabetes and Its Burden in the United States, Centers for Disease Control and Prevention, Atlanta, GA, 2020.
-
3
American Diabetes Association: Economic costs of diabetes in the U.S. in 2017. Diabetes Care 41: 917, 2018.
-
4
Driver VR, Fabbi M, Lavery LA, et al: The costs of diabetic foot: the economic case for the limb salvage team. JAPMA 100: 335, 2010.
-
5
Hicks CW, Selvarajah S, Mathioudakis N, et al: Trends and determinants of costs associated with the inpatient care of diabetic foot ulcers. J Vasc Surg 60: 1247, 2014.
-
6
Borkosky SL, Roukis TS: Incidence of repeat amputation after partial first ray amputation associated with diabetes mellitus and peripheral neuropathy: an 11-year review. J Foot Ankle Surg 52: 335, 2013.
-
7
Ingelfinger JR, Armstrong DG, Boulton AJM, et al: Diabetic foot ulcers and their recurrence. N Engl J Med 376: 2367, 2017.
-
8
Vassallo IM, Gatt A, Cassar K, et al: Healing and mortality rates following toe amputation in type 2 diabetes mellitus. Exp Clin Endocrinol Diabet 129: 438, 2021.
-
9
Littman AJ, Tseng CL, Timmons A, et al: Risk of ipsilateral reamputation following an incident toe amputation among U.S. military veterans with diabetes, 2005-2016. Diabetes Care 43: 1033, 2020.
-
10
Murdoch DP, Armstrong DG, Dacus JB, et al: The natural history of great toe amputations. J Foot Ankle Surg 36: 204, 1997.
Rate and Location of Reulceration and Reamputation After Partial First-Ray Amputation versus Hallux Amputation in Diabetic and Nondiabetic Populations
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Background: We sought to determine the rates of reulceration and reamputation in individuals who underwent partial first-ray amputations versus hallux amputations in diabetic and nondiabetic populations.
Methods: Eighty-four amputations were reviewed in a retrospective fashion. A retrospective medical record review was performed to determine patients who underwent a hallux amputation, both partial and complete, and patients who underwent a partial first-ray amputation. Only patients from 2007 to 2019 were reviewed. The reulceration rate of hallux amputations was 61% compared with a partial first-ray amputation reulceration rate of 74%.
Results: The reamputation rate of hallux amputation versus partial first-ray amputation was 43% versus 51%. At final follow-up, it was statistically significant that patients who underwent hallux amputation were more likely to be healed than those who underwent partial first-ray amputation, regardless of reulceration or reamputation. In addition, patients who underwent hallux amputation went on to digital amputation, and those who underwent partial first-ray amputation went on to transmetatarsal amputation.
Conclusions: Comparing partial first-ray amputation to hallux amputation, hallux amputation patients are more prone to subsequent digital ulceration. Patients who initially undergo hallux amputation have variable subsequent amputations, often digital. Reulceration primarily occurs at the incision site for partial first-ray amputations, with a higher likelihood of subsequent transmetatarsal amputation. Patients with a medical history of diabetes and staged procedures are more likely to receive partial first-ray amputations. However, hallux amputation patients have a lower risk of reulceration and reamputation, regardless of subsequent events. These findings underscore the importance of discussing risks and preventive measures with patients undergoing such amputations, emphasizing postoperative examinations for specific areas of concern. Hallux amputation appears to offer greater protection against reulceration and reamputation for both diabetic and nondiabetic populations.
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