Lee Sang Yoon, Lee Myoung Jin, Byun Sung Bin
Department of Orthopedic Surgery, College of Medicine, Dong-A University, Busan, Korea.
Int J Low Extrem Wounds. 2025 Mar;24(1):156-164. doi: 10.1177/15347346231198940. Epub 2023 Sep 27.
Diabetes mellitus has a global impact, necessitating surgical intervention when conservative methods fail. Transtibial amputation (TTA) is commonly performed on diabetic patients, yet surgical site complications can lead to more procedures. This study aimed to identify factors linked to wound healing issues post-TTA in diabetics.A total of 181 patients who underwent TTA between 2004 and 2021 at a single hospital were included in the study. Exclusion criteria comprised trauma, non-diabetic mellitus, follow-up duration of less than 1 year, incomplete medical records, and surgeries performed by different surgeons. The comparison focused on underlying diseases other than diabetes between the group with wound problems and the group without. Additionally, factors impacting blood flow, such as presurgery hemoglobin levels, intraoperative blood transfusion, the use of antithrombotic or anticoagulant drugs, and the presence of procedures like percutaneous transluminal angioplasty (PTA) and bypass surgery, were analyzed.Among the 181 cases, 22.1% experienced problems at the surgical site while 77.9% did not. Statistical analysis revealed that age was a significant variable affecting wound healing problems after TTA in diabetic patients ( = .007). However, there were no significant differences in wound problems based on comorbidities other than diabetes ( = .209), gender ( = .677), preoperative anemia ( = .102), intraoperative blood transfusion ( = .633), the use of antithrombotic or anticoagulant medications ( = .556), and the performance of PTA or bypass surgery ( = .6).In conclusion, this study found that age was a significant variable affecting wound healing problems after TTA in diabetic patients. Although no association was observed between underlying diseases and wound healing problems, further investigation and cautious management of factors such as preoperative anemia, intraoperative blood transfusion, the use of antithrombotic or anticoagulant drugs, and the performance of PTA or bypass surgery are warranted to prevent complications and optimize wound healing outcomes in diabetic patients undergoing TTA.
糖尿病具有全球影响，在保守治疗方法失败时需要进行手术干预。经胫截肢术（TTA）常用于糖尿病患者，但手术部位并发症可能导致更多手术。本研究旨在确定与糖尿病患者TTA术后伤口愈合问题相关的因素。
共有181例在2004年至2021年期间于一家医院接受TTA手术的患者纳入本研究。排除标准包括创伤、非糖尿病、随访时间少于1年、病历不完整以及由不同外科医生进行的手术。比较重点在于有伤口问题组和无伤口问题组之间除糖尿病外的基础疾病。此外，还分析了影响血流的因素，如术前血红蛋白水平、术中输血、抗血栓或抗凝药物的使用以及经皮腔内血管成形术（PTA）和搭桥手术等操作的存在情况。
在这181例病例中，22.1%的患者手术部位出现问题，而77.9%的患者未出现问题。统计分析显示，年龄是影响糖尿病患者TTA术后伤口愈合问题的一个显著变量（P = 0.007）。然而，基于除糖尿病外的合并症（P = 0.209）、性别（P = 0.677）、术前贫血（P = 0.102）、术中输血（P = 0.633）、抗血栓或抗凝药物的使用（P = 0.556）以及PTA或搭桥手术的实施情况（P = 0.6），伤口问题并无显著差异。
总之，本研究发现年龄是影响糖尿病患者TTA术后伤口愈合问题的一个显著变量。尽管未观察到基础疾病与伤口愈合问题之间存在关联，但仍有必要对术前贫血、术中输血、抗血栓或抗凝药物的使用以及PTA或搭桥手术等因素进行进一步研究和谨慎管理，以预防并发症并优化接受TTA手术的糖尿病患者的伤口愈合结果。
