Yammine Kaissar, Honeine Mohammad, Mouawad Joseph, Orm Ghadi Abou, Jamaleddine Youssef, Assi Chahine
Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, School of Medicine, Lebanese American University, Beirut, Lebanon.
Diabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon.
J Foot Ankle Res. 2025 Jun;18(2):e70052. doi: 10.1002/jfa2.70052.
Diabetic wet gangrene of the toes is a serious condition that puts at risk the limb and life of patients. Two types of amputation are used when infection is around the metatarsophalangeal joint (MTPJ): complete toe disarticulation and toe amputation including metatarsal head resection. Because very few published papers analyzed the results of toe amputation for wet gangrene, our study aimed to evaluate the outcomes of both techniques.
This is a retrospective comparative study of highly selective patients admitted for a single toe/ray diabetic wet gangrene that were treated with toe amputation through MTPJ (TA-MTPJ) versus toe amputation with resection of the metatarsal head (TA-MHR). Three primary outcomes were set for analysis: healing rate and the frequencies of infection recurrence and additional surgeries, including reamputations.
The sample included 31 cases: 12 cases (39%) with TA-MTPJ and 19 cases (61%) with TA-MHR. Outcomes of TA-MTPJ versus TA-MHR were as follows: (a) healing frequency 66.7% versus 58% (p = 0.6), (b) infection recurrence 50% versus 52.6% (p = 0.8), (c) osteomyelitis 41.6% versus 42.1% (p = 0.8), and (d) reamputation 33.3% versus 47.3% (p = 0.4).
This study showed high complications after toe amputation for diabetic digital wet gangrene, with a trend for higher frequency of complications after TA-MHR compared to TA-MTPJ. For any type of amputation required for toe wet gangrene, it is likely that a more proximal level of index amputation is required.
糖尿病足趾湿性坏疽是一种严重的疾病，会危及患者的肢体和生命。当跖趾关节（MTPJ）周围发生感染时，有两种截肢方式：完全趾关节离断术和包括跖骨头切除的趾截肢术。由于很少有已发表的论文分析趾截肢治疗湿性坏疽的结果，我们的研究旨在评估这两种技术的疗效。
这是一项回顾性比较研究，对因单趾/趾列糖尿病湿性坏疽入院的高度选择性患者进行研究，这些患者接受了通过MTPJ的趾截肢术（TA-MTPJ）与跖骨头切除的趾截肢术（TA-MHR）。设定了三个主要结局进行分析：愈合率、感染复发频率和包括再次截肢在内的额外手术频率。
样本包括31例：TA-MTPJ组12例（39%），TA-MHR组19例（61%）。TA-MTPJ与TA-MHR的结局如下：（a）愈合频率分别为66.7%和58%（p = 0.6），（b）感染复发率分别为50%和52.6%（p = 0.8），（c）骨髓炎发生率分别为41.6%和42.1%（p = 0.8），（d）再次截肢率分别为33.3%和47.3%（p = 0.4）。
本研究显示糖尿病足趾湿性坏疽趾截肢术后并发症发生率高，与TA-MTPJ相比，TA-MHR术后并发症频率有更高的趋势。对于足趾湿性坏疽所需的任何类型截肢，可能需要更高水平的初次截肢。
