Tsunehiro Shintani1, Sachi Suzuki2, Naoya Kikuchi1, Takumi Ariya1, Kayoko Natsume1, Kazuhiro Ookura3, Jun Okui4, Yasunori Sato4, Hideaki Obara5. 1. Department of Vascular Surgery, Shizuoka Red Cross Hospital, Shizuoka, Shizuoka, Japan. 2. Department of Plastic and Reconstructive Surgery, Shizuoka Red Cross Hospital, Shizuoka, Shizuoka, Japan. 3. Department of Cardiac Surgery, Shizuoka Red Cross Hospital, Shizuoka, Shizuoka, Japan. 4. Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan. 5. Department of Surgery, Keio University School of Medicine,Tokyo, Japan.
Abstract
Objective: In this study, we aim to evaluate the efficacy of early closed toe amputation on the wound management of toe ulcers with suspected osteomyelitis after revascularization for chronic limb-threatening ischemia (CLTI). Methods: This retrospective study included patients who have underwent revascularization for toe ulcers associated with CLTI at Shizuoka Red Cross Hospital from 2015 to 2021. Wound management comprised early closed toe amputation for toe ulcers with suspected osteomyelitis (19 toes in 17 patients) or conservative treatment (35 toes in 26 patients). The primary endpoint was wound healing after revascularization. We compared the wound healing rate at 90 days and median healing time of early closed toe amputation versus conservative treatment. Results: Compared with the conservative treatment, early closed toe amputation was able to achieve a better wound healing rate at 90 days (89.5% vs. 68.6%; P<0.01) and a shorter median healing time (19 days vs. 62 days; P=0.01). Conclusion: There remains no established wound management for toe lesions associated with CLTI. Despite its several disadvantages including wound infection and possible foot deformity, early closed toe amputation for toe ulcers with suspected osteomyelitis can be considered a safe approach in terms of wound management.
Objective: In this study, we aim to evaluate the efficacy of early closed toe amputation on the wound management of toe ulcers with suspected osteomyelitis after revascularization for chronic limb-threatening ischemia (CLTI). Methods: This retrospective study included patients who have underwent revascularization for toe ulcers associated with CLTI at Shizuoka Red Cross Hospital from 2015 to 2021. Wound management comprised early closed toe amputation for toe ulcers with suspected osteomyelitis (19 toes in 17 patients) or conservative treatment (35 toes in 26 patients). The primary endpoint was wound healing after revascularization. We compared the wound healing rate at 90 days and median healing time of early closed toe amputation versus conservative treatment. Results: Compared with the conservative treatment, early closed toe amputation was able to achieve a better wound healing rate at 90 days (89.5% vs. 68.6%; P<0.01) and a shorter median healing time (19 days vs. 62 days; P=0.01). Conclusion: There remains no established wound management for toe lesions associated with CLTI. Despite its several disadvantages including wound infection and possible foot deformity, early closed toe amputation for toe ulcers with suspected osteomyelitis can be considered a safe approach in terms of wound management.
Authors: Michael S Conte; Andrew W Bradbury; Philippe Kolh; John V White; Florian Dick; Robert Fitridge; Joseph L Mills; Jean-Baptiste Ricco; Kalkunte R Suresh; M Hassan Murad; Victor Aboyans; Murat Aksoy; Vlad-Adrian Alexandrescu; David Armstrong; Nobuyoshi Azuma; Jill Belch; Michel Bergoeing; Martin Bjorck; Nabil Chakfé; Stephen Cheng; Joseph Dawson; Eike S Debus; Andrew Dueck; Susan Duval; Hans H Eckstein; Roberto Ferraresi; Raghvinder Gambhir; Mauro Gargiulo; Patrick Geraghty; Steve Goode; Bruce Gray; Wei Guo; Prem C Gupta; Robert Hinchliffe; Prasad Jetty; Kimihiro Komori; Lawrence Lavery; Wei Liang; Robert Lookstein; Matthew Menard; Sanjay Misra; Tetsuro Miyata; Greg Moneta; Jose A Munoa Prado; Alberto Munoz; Juan E Paolini; Manesh Patel; Frank Pomposelli; Richard Powell; Peter Robless; Lee Rogers; Andres Schanzer; Peter Schneider; Spence Taylor; Melina V De Ceniga; Martin Veller; Frank Vermassen; Jinsong Wang; Shenming Wang Journal: Eur J Vasc Endovasc Surg Date: 2019-06-08 Impact factor: 7.069
Authors: A R Berendt; E J G Peters; K Bakker; J M Embil; M Eneroth; R J Hinchliffe; W J Jeffcoate; B A Lipsky; E Senneville; J Teh; G D Valk Journal: Diabetes Metab Res Rev Date: 2008 May-Jun Impact factor: 4.876
Authors: Benjamin A Lipsky; Éric Senneville; Zulfiqarali G Abbas; Javier Aragón-Sánchez; Mathew Diggle; John M Embil; Shigeo Kono; Lawrence A Lavery; Matthew Malone; Suzanne A van Asten; Vilma Urbančič-Rovan; Edgar J G Peters Journal: Diabetes Metab Res Rev Date: 2020-03 Impact factor: 4.876
Authors: Aroa Tardáguila-García; Irene Sanz-Corbalán; Josep M García-Alamino; Raju Ahluwalia; Luigi Uccioli; José Luis Lázaro-Martínez Journal: J Clin Med Date: 2021-03-17 Impact factor: 4.241