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Susceptibility Factors for Early Reamputation in Diabetic Great Toe Gangrene

Author(s):

Raden Andri Primadhi*   Pages 1 - 8 ( 8 )

Abstract:


Introduction: The effectiveness and efficiency of the treatment has long been important in diabetes and its complications, especially in the developing countries. Prolonged hospitalization and repeated surgery should be avoided due to clinical and economical reasons. Wound breakdowns or necrosis can occur after amputation procedures, and subsequently will require reamputation. This study analysed susceptibility factors in diabetic foot patients undergoing prior great toe amputation that are thought to be related to early reamputation.

Method: We performed a retrospective analysis in 107 patients that have undergone amputation for great toe gangrene, during May 2014-April 2019. Demographic data, clinical features, laboratory results and treatment modality were documented and statistically analysed by simple and multiple logistic regression method.

Results: Of all 107 patients, 17 patients had to undergo early reamputation. Limited dorsiflexion, level of amputation, and sepsis condition is shown to be significantly associated with early amputation. Multiple logistic regression analysis confirmed a significant association of early reamputation with amputation or disarticulation at level of metatarsophalangeal joint.

Conclusion: While limited ankle dorsiflexion and sepsis condition need to be addressed comprehensively, from the surgical options point of view we suggest ray amputation to be preferred over metatarsophalangeal joint disarticulation to prevent early reamputation.

Keywords:

Diabetes, Gangrene, Surgery, Reamputation

Affiliation:

Department of Orthopaedics and Traumatology Universitas Padjadjaran Medical School / Hasan Sadikin Hospital Jalan Pasteur 38 Bandung



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