Why Partial First Ray Amputations In Patients With Diabetic Neuropathy Do Not Work
- Volume 26 - Issue 10 - October 2013
- 9025 reads
- 2 comments
Further, after review of our studies, it may be in the patient’s best interest to get a referral to a more specialized diabetic foot center of excellence since the incidence of re-amputation is half of what results when the patient receives care in a community-based facility. The exact reason for this remains a matter for conjecture since the same multidisciplinary team members (i.e., internal medicine/endocrinologists, infectious disease, vascular surgery, nutritionists, etc.) are present in both settings studied. Further study to elucidate this apparent discrepancy (including non-hospital based private practitioner outcomes) is warranted.
Given the stated goals of surgical intervention, one should not consider any level of amputation that results in the need for further ongoing treatment for re-ulceration with weekly clinical evaluations, local wound management and oral antibiotic therapy as a successful outcome even in the situation of initial healing. In addition to concerns over limb- and life-threatening infection developing, healthcare costs associated with repeated clinical debridement, wound dressings and oral antibiotics are high. Patient satisfaction in the setting of complicated and time consuming dressings and intolerance of prolonged oral antibiotic therapy is also poor.
In light of this, one may consider a single definitive and predictable procedure (such as a primary transmetatarsal amputation) at the time of initial intervention to be more satisfactory to the patient overall.29 Proper patient education is required at the time of surgical consultation to allow for proper decision making in this regard. In addition, one should consider surgical correction of any related foot deformities, such as hammering of the lesser digits, to prevent future ulcerations.30,31
Dr. Borkosky is a graduate with distinction of the Rearfoot/Ankle Surgery Residency at the Gundersen Health System in La Crosse, Wis. She is in private practice at the Palmetto Podiatry Group in Andersen, S.C. Dr. Borkosky is an Associate of the American College of Foot and Ankle Surgeons.
Dr. Roukis is attending staff in the Department of Orthopaedics, Podiatry and Sports Medicine at Gundersen Healthcare System in La Crosse, Wis. He is the President-Elect and a Fellow of the American College of Foot and Ankle Surgeons.