Internal Pedal Amputation in Diabetic Forefoot Ulcers

Abstract

Objective Approximately 80 percent of diabetic foot wounds arise from the front foot. Most of these wounds are associated with bone and joint involvement. Toe amputations and ray amputations are the most frequently performed surgical interventions for the lesions limited to front foot. Many diabetic patients refuse surgery although they have advanced deformities that may cause dangerous injuries. Considering these patients, we defined a new alternative surgical procedure protecting the external appearance of the toe. This surgical procedure is not perceived by patients as a toe-consuming operation. Materials and Method Between 01-04-2004 and 08-11-2012, 76 toe lesions of 66 diabetic patients were treated with a new surgical approach. 50 patients were male and 16 were female. Mean age was 60.4, mean duration of diabetes was 16,6 years. Results The mean follow up duration was 26.4 months (range 12.0 to 71.4). In 47 patients, the surgical closure healed by primary intention (81%). Dehiscence occurred in 11 patients (19%). Infection of the surgical wound developed in four patients (6,9%). Ulcer relapse occurred in three patients (5.1%). In six patients (10.3%), an ulcer developed in the contralateral foot. Long term follow up revealed that almost the same or approximately close toe length and width without any deformity were seen in 66 toes (in 58 patients). Conclusion Removal of the involved bone and other involved tissues while preserving the skin and other healthy tissues to reconstruct an acceptable new toe is possible in this new technique.