LeSavage Lindsay K, Hoffler Hayden L, Evans Joni K, Blazek Cody D
Resident, Podiatric Medicine and Surgery Residency Program, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC.
Fellow, Southeast Permanente Foot & Ankle Trauma & Reconstructive Fellowship, Atlanta, GA.
J Foot Ankle Surg. 2023 May-Jun;62(3):482-486. doi: 10.1053/j.jfas.2022.11.014. Epub 2022 Nov 25.
Reulceration is a common complication following ray amputations of the foot. The primary aim of this study was to evaluate the incidence of re-ulceration following isolated and combined central ray amputations. This was a retrospective review of 55 consecutive limbs that underwent central ray amputations at Wake Forest Baptist Medical Centers. Procedures were performed at the 3 central rays or a combination of central rays. Incidence of postoperative ulceration was evaluated on the ipsilateral foot. We hypothesized there would not be an association between which ray was resected and development of reulceration. 24 patients (43%) experienced repeat ulceration following a central ray amputation. Median follow up time was 17.4 months (range 4 days to 99 months). The estimated ulcer recurrence rate at 1 year was 41.8%. There was no statistical difference based on location of amputation (second, third, 4 rays) with regards to reulceration, further amputation, transmetatarsal amputation, or below knee amputations. However, reulceration seemed to be much quicker in those patients undergoing a third ray amputation. Like the medial and lateral rays, central ray amputations can be a good initial salvage procedure to clear devitalized tissue and prevent the spreading of infection. The results of the present study suggest that there is no detectable difference between location of central ray amputations and development of re-ulceration, more proximal amputations, or death among this cohort.
足部射线截肢术后溃疡复发是一种常见并发症。本研究的主要目的是评估孤立和联合中央射线截肢术后溃疡复发的发生率。这是一项对在韦克福里斯特浸礼会医疗中心接受中央射线截肢的55例连续肢体进行的回顾性研究。手术在3条中央射线或中央射线组合处进行。对同侧足部评估术后溃疡的发生率。我们假设切除的射线与溃疡复发的发生之间不存在关联。24例患者（43%）在中央射线截肢后出现溃疡复发。中位随访时间为17.4个月（范围4天至99个月）。1年时估计的溃疡复发率为41.8%。就溃疡复发、进一步截肢、经跖骨截肢或膝下截肢而言，截肢部位（第二、第三、第四射线）之间无统计学差异。然而，接受第三射线截肢的患者溃疡复发似乎快得多。与内侧和外侧射线一样，中央射线截肢可以是清除失活组织和防止感染扩散的良好初始挽救手术。本研究结果表明，在该队列中，中央射线截肢部位与溃疡复发、更近端截肢或死亡的发生之间没有可检测到的差异。
