title: Outcomes of Chopart Amputation in a Tertiary Referral Diabetic Foot Clinic: Data From a Consecutive Series of 83 Hospitalized Patients.
abstract: The purpose of the present retrospective study was to evaluate the outcomes (ie, ulcer recurrence, major amputation, death) in diabetic patients undergoing Chopart amputation because of deep infection or gangrene extending to the midfoot. From 2009 to 2011, 83 patients, aged 71.4 ± 9.3 years, underwent a midtarsal amputation and were followed up until December 31, 2012 (mean follow-up 2.8 ± 0.8 years). Of the 83 patients, 26 were female, 61 required insulin, 47 had renal insufficiency, 19 underwent hemodialysis, 65 had hypertension, 34 had a history of cardiac disease, and 4 had a history of stroke. Chopart amputation was performed in 38 patients (45.8%) with gangrene, 31 (37.4%) with abscess, and 14 (16.9%) with osteomyelitis. Urgent surgery was performed in 56 patients (67.5%). Effective revascularization was performed in 64 patients (77.1%) patients. Of the 83 patients, 47 had healed at a mean period of 164.7 (range 11 to 698) days. Ulcer recurrence developed in 15 patients (31.9%). A major amputation was necessary in 23 patients (27.7%), with an annual incidence of 13.0%. None of the included variables on logistic regression analysis was significantly associated with proximal amputation. Of the 83 patients, 38 (45.8%) died, with an annual incidence of 25.8%. On logistic regression analysis, age (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.01 to 1.16), history of stroke (OR 9.94, 95% CI 3.16 to 31.24), and urgent surgery (OR 2.60, 95% CI 1.14 to 5.93) were associated with mortality. Chopart amputation represents the last chance to avoid major amputation for diabetic patients with serious foot complications. Our success rate was great enough to consider Chopart amputation a viable option for limb salvage in this high-risk population.
authors.affiliation: Scientific Director, Diabetic Foot Centre, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
authors.forename: Ezio
authors.initials: E
authors.lastname: Faglia
authors.affiliation: Chief, Diabetic Foot Centre, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy. Electronic address: giacomo.clerici@multimedica.it.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Clerici
authors.affiliation: Director, Podiatry Service, Carl T. Hayden Veteran Affairs Medical Center, Phoenix, AZ.
authors.forename: Robert
authors.initials: R
authors.lastname: Frykberg
authors.affiliation: Associate Physician, Diabetic Foot Centre, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Caminiti
authors.affiliation: Associate Physician, Diabetic Foot Centre, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Curci
authors.affiliation: Consultant, Diabetic Foot Centre, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cetta
authors.affiliation: Consultant, Fondazione Onlus DeaMedica, Pagani, Salerno, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Prisco
authors.affiliation: Consultant, Fondazione Onlus DeaMedica, Pagani, Salerno, Italy.
authors.forename: Rosaria
authors.initials: R
authors.lastname: Greco
authors.affiliation: Consultant, Fondazione Onlus DeaMedica, Pagani, Salerno, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Prisco
authors.affiliation: Director, Medical Statistics Unit, Milan University, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Morabito
mesh_terms: D000038:Abscess / Q000209:etiology / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000009:adverse effects; D017719:Diabetic Foot / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005734:Gangrene / Q000209:etiology / Q000601:surgery; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D014945:Wound Healing
keywords: diabetes mellitus; foot ulcer; hospitalization; incidence of healing; lower extremity amputation; mortality