Mini-Invasive Approach and Minor Amputation in the Management of Diabetic Foot Ulcer: A Retrospective Study of 110 Cases

Abstract

Category:Diabetes; OtherIntroduction/Purpose:The diabetic foot is an increasing issue over the last years. The 25% of diabetic patients have a risk to develop a diabetic foot ulcer (DFU) in their lifetime, among these, the 28% of patients will result in an amputation. The amputation is associated with a high rate of complications. Therefore, percutaneous mini-invasive (PMI) approaches and minor amputations (MA) have a widespread use in the last years. The aim of our work is to evaluate the clinical and functional outcomes of PMI and MA in the treatment of recurrences and unhealed DFU after conservative treatment.Methods:We retrospectively enrolled 110 patients treated in our orthopedic department in Perugia between January 2012 and October 2019. Included were the patients underwent to a PMI or MA treatment after failed conservative treatment for 12 weeks. The PMI technique consist of flexor tenotomy, metatarsal osteotomy and resection arthroplasty sec. Kessler. DFU were classified according to the Texas Foot Ulcer Classification. Exclusion criteria were: patient affected by peripheral vasculopathy disease, previous major amputation, psychiatric disease. The patients were divided in 2 groups. The group A included 57 patients treated with PMI, mean age 62.8 y.o. (range 50-80). The group B included 53 patients treated with MI, mean age 66.2 y.o. (range 53-85). The mean follow up was 18 months (range 4-40 months). Clinical outcomes, complication's rate, functional scores (FFI and VAS- FA) were assessed. The statistical analysis was performed with the t-student test, the significativity value was set p<0.05.Results:In the group A, the patients had a healing's rate in 90,7 % of cases, the ulcer was healed in average in 5.77 weeks ( range 4-8.1). The postoperative complications accounts 35% of cases, including 2 cases of osteomyelitis, 1 acute Charcot foot, 1 case of acute renal insufficiency and pneumonia. Transfer ulcer occurred in 12.96%. Overall a reintervention with a mini-invasive approach was performed in 2 cases. Group B healed in 77% of cases, in a mean time of 9.11 weeks (range 8-13.3), no postoperative complication occurred. In 23% of patients occurred a transfer ulcer after an average time of 30 months, in 1 case a major amputation was mandatory. The mean value at postoperative follow-up was 78 for VAS-FA for group A and 72.2 for group B, the FFIindex was 70% for group A and 68% for group B.Conclusion:The PMI and AM are effective procedures for the treatment of DFU, associated with low complications rate, fast recovery and ulcer's healing process, low rate of recurrences and ulcer transfer. Overall the percutaneous technique show encouraging results, however, these procedures must be addressed to the patient's feature. As prospective, in the future percutaneous treatments might play a role in prevention's strategy.