Blanchette Virginie, Houde Louis, Armstrong David G, Schmidt Brian M
Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières, Canada, G9A 5H7.
Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, 1520 San Pablo, St. Los Angeles, CA, 90031, USA.
Int J Low Extrem Wounds. 2025 Mar;24(1):225-234. doi: 10.1177/15347346221122859. Epub 2022 Sep 7.
There are few data comparing outcomes after hallux amputation or partial first ray resection after diabetic foot ulcer (DFU). In a similar context, the choice to perform one of these two surgeries is attributable to clinician preference based on experience and characteristics of the patient and the DFU. Therefore, the purpose of this study was to determine the more definitive surgery between hallux amputation and partial first ray resection. We abstracted data from a cohort of 70 patients followed for a 1-year postoperative period to support clinical practice. We also attempted to identify patient characteristics leading to these outcomes. Our results suggested no statistical difference between the type of surgery and outcomes such as recurrence of DFU and amputation at 3, 6, and 12 months or death. However, there was a statistically significantly increased likelihood of re-ulceration for patients with CAD who underwent hallux amputation (p = 0.02). There was also a significantly increased likelihood of re-ulceration for people with depression or a history when the partial ray resection was performed (p = 0.02). Patients with prior amputation showed a higher probability of undergoing another re-amputation with partial ray resection (p = 0.01). Although the trends that emerge from this project are limited to what is observed in this statistical context, where the number of patients included and the number of total observations per outcome were limited, it highlights interesting data for future research to inform clinical decisions to support best practices for the benefit of patients.
关于糖尿病足溃疡（DFU）后拇趾截肢或部分第一跖骨切除术后的预后比较，相关数据较少。在类似情况下，选择进行这两种手术之一归因于临床医生基于患者及DFU的经验和特征的偏好。因此，本研究的目的是确定拇趾截肢和部分第一跖骨切除这两种手术中更具决定性的手术方式。我们从一组70例患者中提取数据，对其进行为期1年的术后随访以支持临床实践。我们还试图确定导致这些预后的患者特征。我们的结果表明，手术类型与DFU复发、3个月、6个月和12个月时的截肢或死亡等预后之间无统计学差异。然而，接受拇趾截肢的CAD患者再次溃疡的可能性在统计学上显著增加（p = 0.02）。进行部分跖骨切除时，有抑郁症或病史的患者再次溃疡的可能性也显著增加（p = 0.02）。既往有截肢史的患者接受部分跖骨切除后再次截肢的概率更高（p = 0.01）。尽管该项目得出的趋势仅限于此统计背景下观察到的情况，即纳入的患者数量和每个预后的总观察数量有限，但它突出了有趣的数据，可为未来研究提供参考，以指导临床决策，支持为患者谋福利的最佳实践。
