Preserving Functional Capacity as Opposed to Tissue Preservation in the Diabetic Patient
| العنوان: | Preserving Functional Capacity as Opposed to Tissue Preservation in the Diabetic Patient |
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| المؤلفون: | Niten Singh, Charles A. Andersen, Thomas S. Roukis |
| المصدر: | Foot & Ankle Specialist. 3:177-183 |
| بيانات النشر: | SAGE Publications, 2010. |
| سنة النشر: | 2010 |
| مصطلحات موضوعية: | Male, medicine.medical_specialty, medicine.medical_treatment, Amputation, Surgical, Gangrene, medicine, Humans, Orthopedics and Sports Medicine, Podiatry, Metatarsal Bones, Aged, Retrospective Studies, Varus deformity, business.industry, Osteomyelitis, Forefoot, Vascular bypass, Equinus Deformity, Retrospective cohort study, Recovery of Function, Middle Aged, medicine.disease, Survival Analysis, Diabetic Foot, Surgery, Amputation, Ambulatory, Female, business |
| الوصف: | The authors performed a retrospective review of prospectively collected data of all diabetic patients who underwent transmetatarsal amputation (TMA) for toe gangrene or neuropathic ulceration from May 2006 to June 2009. Twenty-nine TMAs were performed in diabetic patients during the study period, including 24 men and 5 women with a mean ± SD age of 66.3 ± 7.5 years. The indications for TMA were gangrene of ≥ 2 digits in 12 patients (41%) and neuropathic ulceration with underlying osteomyelitis or abscess and a concomitant dysfunctional forefoot in 17 patients (59%). Of the 12 patients who presented with toe gangrene, 7 (58%) underwent endovascular intervention and 5 (42%) underwent open vascular bypass. Equinus contracture was present in 27 patients (93%), and 26 (96%) of these patients underwent tendo-Achilles lengthening or gastrocnemius recession. Correction of equinus contracture was not performed in 1 patient as it was deemed not feasible. Forefoot varus deformity was present in 22 (76%) patients, and balancing was performed in 17 of these patients (77%) with skeletal stabilization or tendon transfer. Balancing was not performed in the remaining patients as it was not necessary or not feasible. Sixteen patients (55%) healed primarily and 5 patients (17%) developed minor wound separation that healed via secondary intention. An additional 4 patients were able to maintain functional revision procedures confined to the foot (1 TMA revision, 3 Chopart amputations). Three patients (10%) required below-knee amputation, and there were 2 deaths (7%) during the time period. Functional amputation confined to the foot was achieved in 86% of ambulatory diabetic patients. These results support a more aggressive initial approach in ambulatory diabetic patients with multiple digital ulcerations, allowing this patient population to remain functional and avoid multiple reoperations and ultimately major amputation. |
| تدمد: | 1938-7636 1938-6400 |
| DOI: | 10.1177/1938640010374217 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::cb8ddcc0a2f5321e8bcd5cc3c53c3022 https://doi.org/10.1177/1938640010374217 |
| Rights: | CLOSED |
| رقم الانضمام: | edsair.doi.dedup.....cb8ddcc0a2f5321e8bcd5cc3c53c3022 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 19387636 19386400 |
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| DOI: | 10.1177/1938640010374217 |