title: Toe-Sparing Surgery for Neuropathic Toe Ulcers With Exposed Bone or Joint in an Outpatient Setting: A Retrospective Study.
abstract: The purpose of this study was to review the results of aggressive surgical debridement of neuropathic toe ulcers with exposed bone or joint. We identified patients with a single toe ulcer with exposed bone or joint that had been operated on in an outpatient setting. The surgery had included aggressive debridement and was performed using a small curette and rongeur, followed by oral antibiotic treatment at home. Success was defined as complete healing with no recurrence 6 months after full wound closure and epitheliazation was achieved. Twenty-five patients with neuropathic toe ulcers (72% male) had a total of 26 primary operations. Their mean age was 60 ± 12 years. In 22 patients, the neuropathy resulted from diabetes mellitus of 17 ± 9 years' duration. The mean ulcer duration was 6 weeks (range 1-24). The mean number of visits per patient was 6.5 (range 3-20). The ulcers closed in a median of 5 weeks (8 ± 6 weeks, range 3-24 weeks, Q1-Q3 4-10 weeks). At 6 months, 3 (11.5%) patients had needed a toe amputation for infection or necrosis that could not be controlled. None needed a major amputation or hospitalization related to the ulcer. Toe-sparing surgery is feasible and in a select population can have a high success rate (88%), even though it does dictate more dedicated patient care.
authors.affiliation: Assaf HaRofeh Medical Center, Tel Aviv University, Zerrifin, Israel Maccabi Health Services, Tel Aviv, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Tamir
authors.affiliation: Assaf HaRofeh Medical Center, Tel Aviv University, Zerrifin, Israel Maccabi Health Services, Tel Aviv, Israel asff@inter.net.il.
authors.forename: Aharon S
authors.initials: AS
authors.lastname: Finestone
authors.affiliation: Assaf HaRofeh Medical Center, Tel Aviv University, Zerrifin, Israel.
authors.forename: Erez
authors.initials: E
authors.lastname: Avisar
authors.affiliation: Assaf HaRofeh Medical Center, Tel Aviv University, Zerrifin, Israel.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Agar
mesh_terms: D000368:Aged; D003646:Debridement / Q000379:methods*; D017719:Diabetic Foot / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D003929:Diabetic Neuropathies / Q000150:complications*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014034:Toes / Q000294:innervation / Q000601:surgery*; D014945:Wound Healing
keywords: diabetic foot; neuropathic ulcer; osteomyelitis; septic arthritis