title: [Hallux amputation].
abstract: OBJECTIVE
  Debridement of infected tissue with the main aim being the re-establishment of mobilization with preservation of standing and walking ability. Prevention of secondary pressure points or amputations due to inadequate resection or deficient soft tissue cover.
  
  
  METHODS
  In the case of increasing necrosis of the big toe, surgical abrasion and/or amputation is considered unavoidable. Other indications where surgery could be considered include diabetes and its associated angiopathies together with peripheral arterial angiopathy.
  
  
  METHODS
  In the case of insufficient blood supply an expansion of the resection margins should be taken into account. If there are possible alternatives to amputation. Surgery for patients with renal failure requiring dialysis associated with increased complication rate.
  
  
  METHODS
  A dorsal cuneiform resection is performed to facilitate implantation of a plantar skin transplant and wound healing. Important is the resection of bone in a slide oblique technique. Amputation scars should be outside pressure zones. Partial amputations in the area of the first ray as exarticulation or via the individual amputated segments possible (as opposed to toes 2-5).
  
  
  METHODS
  Direct postoperative weight-bearing with rigid insole and dispensing aid for 6-8 weeks. Following complete wound healing, foot support with orthopedic arch and transverse strain relief should be advocated, together with a joint roll in ready-made individual shoes.
  
  
  RESULTS
  Both trauma and nontrauma cases were included in our present cohort. A total of 7 cases were surgically revised in 2014 due to superficial skin necrosis that was likely the result of skin tension from the wound stitches.
authors.affiliation: Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert Schweitzer Campus 1, Gebäude W1, Waldeyerstr. 1, 48149, Münster, Deutschland. ochman@uni-muenster.de.
authors.forename: S
authors.initials: S
authors.lastname: Ochman
authors.affiliation: Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert Schweitzer Campus 1, Gebäude W1, Waldeyerstr. 1, 48149, Münster, Deutschland.
authors.forename: M J
authors.initials: MJ
authors.lastname: Raschke
authors.affiliation: Department für Fuß- und Sprunggelenkchirurgie, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH) im Diakoniekrankenhaus Annastift, Hannover, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Stukenborg-Colsman
authors.affiliation: Department für Fuß- und Sprunggelenkchirurgie, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH) im Diakoniekrankenhaus Annastift, Hannover, Deutschland.
authors.forename: K
authors.initials: K
authors.lastname: Daniilidis
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D003646:Debridement / Q000379:methods*; D062109:Dermatologic Surgical Procedures / Q000379:methods; D017719:Diabetic Foot / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006214:Hallux / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome
keywords: Angiopathy; Diabetes; Limb salvage; Minor amputation; Peripheral arterial disease