|Beitragstitel||Long-term results after internal partial forefoot amputation (resection)|
Internal partial forefoot amputation of a phalanx or metatarsal head is a treatment option, which can prevent minor or major amputation in the treatment of osteomyelitis refractory to antibiotic therapy and in the treatment of refractory and recurrent chronic ulcers of the forefoot.
Disadvantages of this treatment option are the problem of ulcer recurrence and transfer lesions and of a high rate of re-amputation.
The aim of our study was to control if internal partial forefoot amputation is a valuable treatment option with regard of the healing rate of osteomyelitis and/or chronic ulceration, risk of ulcer recurrence at the same area or re-ulceration at a different area and revision rate.
We included all patients who underwent internal partial forefoot amputation of a phalanx or metatarsal head at our institution because of chronic ulceration of the forefoot and/or osteomyelitis from 2004 to 2014. Information about patient characteristics, healing of ulceration, new ulcer occurrence, and revision surgery were collected. Kaplan-Meier survival curves were plotted for new ulcer occurrence and revision surgery.
A total of 102 patients (mean age 67.6 years) were included with 108 operated feet. In 60 (55.6%) cases the patient had diabetes disease. In 56 cases a metatarsal head resection was performed, in 5 cases an isolated resection of sesamoids and in 57 cases an internal partial amputation of a phalanx. The mean follow-up was 40 months. 93.3% of ulcers healed after a mean period of 3.3 months, In 56 feet (52.3%) a new ulcer appeared: It was localized at the same area as initial ulcer in 11 cases (= ulcer recurrence), in 45 cases it was localized elsewhere (= re-ulceration). Ulcer recurrence occurred after a mean period of 10 months, re-ulceration after a mean period of 16.4 months. Revision surgery was necessary in 39 feet (36.1%). The mean time interval to first revision surgery was 16.8 months. Only one major amputation and 6 complete transmetatarsal forefoot amputations were necessary during the follow-up.
Internal partial forefoot amputations are a successful treatment of osteomyelitis refractory to antibiotic treatment and of chronic ulcers of the forefoot. However, new ulceration is a frequent event following this type of surgery. Our results are consistent with the reported re-ulceration rate after conservative treatment of diabetic foot ulcers. The number of major amputations can be reduced with this procedure.