520-P: Bedside Amputation Surgery for Isolated Toe(s) Necrosis in a Diabetes Department—Prognostic after One-Year Follow-up

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For isolated toe(s) necrosis complicating diabetic foot ulcers (DFU), level of amputation is a frequent topic of disagreement between diabetologists and surgeons. Bedside Amputation Surgery (BAS) performed by a diabetologist might be an option to get rid of a major surgery (complete transmetatarsal amputation [TMA] or transtibial amputation [TTA]) usually and initially recommended by the surgeon in this case. Indications of this practice need to be specified. This monocentric, retrospective, observational study assessed the outcome at 1 year of patients with diabetes mellitus (DM) after an accessible BAS performed by the diabetologist for isolated and delimited toe(s) necrosis consisting of transphalangeal amputation, metatarsophalangeal disarticulation or TMA of one axis. The primary endpoint is the one-year healing rate without secondary surgery performed by a surgeon in the operating room. Out of 783 patients admitted for DFU (05/2016-10/2021), 66 underwent BAS (8.5%). One-year follow-up was achieved for 55 patients (5 deaths from other causes and 6 lost of follow-up): males 82%, type 2 DM 96%, DM median duration 18 years, median HbA1C 9%. One-year healing rate was 62% (34/55). Among 21/55 patients with no healing at 1 year, 19 received secondary surgery in the operating room (TTA 32% (6/19), complete TMA 37% (7/19) and revision surgery gesture 31% (6/19), median delay: 41 days). Failure was observed in patients with more severe leg arteriopathy (1 vs 2 vascular leg axes, p=0.03) with no significant difference in foot vascularization. Soft tissue infection at the time of BAS was significantly more present in the unhealed group (80% vs 47%, p=0.02) with a higher CRP level (84 vs 23mg/L, p= 0.001). BAS allows optimal care in about 2 out of 3 cases, avoiding the need to perform major surgeries. The number of vascular leg axes (<1) as well as degree of soft tissue infection need to be assessed before suggesting the indication. Disclosure F.Féron: None. J.Riveline: Board Member; Abbott Diabetes, Medtronic, Dexcom, Inc., Novo Nordisk, Eli Lilly and Company, Sanofi. J.Gautier: Advisory Panel; Bayer Inc., Eli Lilly and Company, Sanofi, Other Relationship; Novo Nordisk. J.Kevorkian: None.