title: Outcome of limited forefoot amputation with primary closure in patients with diabetes.
abstract: Limited forefoot amputation in diabetic patients with osteomyelitis is frequently required. We retrospectively reviewed diabetic patients with osteomyelitis, an unhealed ulcer and blood pressure in the toe of > 45 mmHg who underwent limited amputation of the foot with primary wound closure. Between 2006 and 2012, 74 consecutive patients with a mean age of 67 years (29 to 93), and a median follow-up of 31 months, were included. All the wounds healed primarily at a median of 37 days (13 to 210; mean 48). At a median of 6 months (1.5 to 18; mean 353 days), 23 patients (31%) suffered a further ulceration. Of these, 12 patients (16% of the total) required a further amputation. We conclude that primary wound closure following limited amputation of the foot in patients with diabetes is a safe and effective technique when associated with appropriate antibiotic treatment.
authors.affiliation: Addenbrooke's Hospital, Orthopaedic Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: N
authors.initials: N
authors.lastname: Shaikh
authors.forename: P
authors.initials: P
authors.lastname: Vaughan
authors.forename: K
authors.initials: K
authors.lastname: Varty
authors.forename: A P
authors.initials: AP
authors.lastname: Coll
authors.forename: A H N
authors.initials: AH
authors.lastname: Robinson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000379:methods*; D019072:Antibiotic Prophylaxis / Q000379:methods; D001794:Blood Pressure / Q000502:physiology; D017719:Diabetic Foot / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005545:Forefoot, Human / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology / Q000601:surgery; D011182:Postoperative Care / Q000379:methods; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D014034:Toes / Q000098:blood supply; D016896:Treatment Outcome; D058106:Wound Closure Techniques; D014945:Wound Healing / Q000502:physiology
keywords: Amputation; Diabetes; Foot; Osteomyelitis; Primary closure; Ulcer