title: Ulcer recurrence following first ray amputation in diabetic patients: a cohort prospective study.
abstract: OBJECTIVE
  To evaluate the reulceration and reamputation rates in a cohort of diabetic patients following first ray amputation.
  
  
  METHODS
  We evaluated a cohort of 89 diabetic patients, 63 men and 26 women, who underwent first ray amputation in the period from January 2000 to December 2001. The first ray lesions were Wagner grade 2 in 3 patients, Wagner grade 3 in 47 patients, and Wagner grade 4 in 39 patients. Following surgical wound healing, all patients wore special footwear with rocker bottom soles and custom molded insoles and were put on an intensive secondary prevention program.
  
  
  RESULTS
  The mean follow-up duration was 16.35 +/- 6.76 months (range 7-28). Fifteen patients developed new ulcerations, with 11 lesions occurring ipsilaterally and 4 contralaterally to the first ray amputation. In seven patients, the new lesion was treated and healed with dressing. Eight patients underwent a new surgical procedure: panmetatarsal head resection in four patients, toe amputation in two patients, a transmetatarsal amputation in one patient, and Lisfranc's amputation in one patient.
  
  
  CONCLUSIONS
  In the population studied, the first ray amputation presented a lower reulceration and reamputation rate with respect to that reported in the literature. This finding should therefore be attributed to the follow-up program, which uses shoes with a rocker bottom sole and custom molded insoles and intensive ambulatory check-ups.
authors.affiliation: Diabetic Foot Unit, Presidio Ospedaliero Abano Terme, Padova, Italy. ldallapaola@libero.it
authors.forename: Luca
authors.initials: L
authors.lastname: Dalla Paola
authors.forename: Ezio
authors.initials: E
authors.lastname: Faglia
authors.forename: Maurizio
authors.initials: M
authors.lastname: Caminiti
authors.forename: Giacomo
authors.initials: G
authors.lastname: Clerici
authors.forename: Sasa
authors.initials: S
authors.lastname: Ninkovic
authors.forename: Valter
authors.initials: V
authors.lastname: Deanesi
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000379:methods*; D017719:Diabetic Foot / Q000517:prevention & control / Q000601:surgery*; D003930:Diabetic Retinopathy / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000473:pathology; D012008:Recurrence; D012775:Shoes; D014945:Wound Healing