Resident, Podiatric Medicine and Surgery Residency Program, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC.
Resident, Podiatric Medicine and Surgery Residency Program, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC.
J Foot Ankle Surg. 2022 Mar-Apr;61(2):298-304. doi: 10.1053/j.jfas.2021.08.007. Epub 2021 Aug 21.
Ulceration or reulceration is a common complication following partial or total fifth ray amputations. The primary aim of this study was to evaluate the incidence of reulceration following partial fifth ray amputations. This was a multicenter review of 117 consecutive limbs that underwent partial fifth ray amputations at the University of Pittsburgh Medical Center and Wake Forest Baptist Medical Centers. Procedures were performed at various levels along the fifth metatarsal. Incidence of postoperative ulceration was evaluated on the ipsilateral foot. We hypothesized there would be an association between location of resection and development of reulceration. Seventy-one of 117 patients (60.7%) experienced repeat ulceration following a partial fifth ray amputation. Median follow-up time was 19 months. There was no statistical difference based on location of amputation (proximal, middle, distal, isolated base) with regards to reulceration (p = .166), further amputation (p = .271), transmetatarsal amputation (p = .160), or below knee amputation (p = .769). There was statistical significance in the follow up time between study sites (p = .013), fifth ray amputation reoperation rate between study sites (p = .001), and reulceration rates between study sites (p = .017). Partial fifth ray amputations can be a good initial salvage procedure to clear infection and prolong bipedal ambulatory status. The results of the present study put forward that there is not an association between location of amputations of the fifth ray and development of reulceration, transfer lesions or more proximal amputations.
溃疡或再溃疡是部分或全部第五跖骨截肢后的常见并发症。本研究的主要目的是评估部分第五跖骨截肢后再溃疡的发生率。这是对匹兹堡大学医学中心和维克森林浸信会医学中心连续 117 例肢体进行部分第五跖骨截肢的多中心回顾性研究。手术在第五跖骨的不同水平进行。同侧足部评估术后溃疡的发生率。我们假设切除部位与再溃疡的发生之间存在关联。117 例患者中有 71 例（60.7%）在部分第五跖骨截肢后出现复发性溃疡。中位随访时间为 19 个月。根据截肢部位（近端、中段、远端、孤立基底），再溃疡（p=0.166）、进一步截肢（p=0.271）、经跖骨截肢（p=0.160）或膝下截肢（p=0.769）之间无统计学差异。不同研究地点的随访时间（p=0.013）、第五跖骨截肢再手术率（p=0.001）和再溃疡率（p=0.017）存在统计学差异。部分第五跖骨截肢术可以作为清除感染和延长双足步行状态的良好初始挽救手术。本研究结果表明，第五跖骨截肢的部位与再溃疡、转移病灶或更近端截肢的发生之间没有关联。
