Evolution after toe amputation related to diabetic foot

Abstract

Ulcerated lesions on the feet of diabetic patients are a major health concern worldwide. They are responsible for the greatest burden related to mortality, morbidity and the economic cost of the disease. The objective of this study was to evaluate diabetic patients undergoing toe amputation regarding their need for a second surgical procedure including major amputation, mortality, and revascularization at three and 12 months of follow-up as well as glycated hemoglobin levels. A retrospective cohort study was performed evaluating the evolution of consecutive patients with diabetic foot hospitalized in Hospital de Base in 2022 for toe amputation. Complications and glycated hemoglobin levels in the follow-up period were analyzed at two post-surgery timepoints: three and 12 months. These complications comprised the need for a second surgical procedure including major amputation, mortality, and revascularization. Eighty-three patients with an overall mean age of 61.2 years underwent toe amputations during the study period. Of the 63 patients, 20 were women with a mean age of 63.45 years and 63 were men with a mean age of 60.56 years (unpaired t-test; p-value = 0.2). Seven (8.4%) patients died, 2 (2.4%) underwent infrapatellar amputations and 28 (33.73%) were submitted to revascularization during this period. Glycated hemoglobin levels ranged from 6.9-14.2% with a mean of 9.2%. Diabetic patients require preventive care to reduce the risk of foot injuries and rapid treatment of wounds, prioritizing a vascular assessment to check whether the blood flow is sufficient to heal lesions with adequate infection control using bacterial wound cultures and antibiograms.