Recherche clinique sur le pied et la cheville

Abstrait

Toe Wounds Treated with Percutaneous Transluminal Angioplasty and Toe Amputation in Hemodialysis Patients with Diabetic Nephropathy: Wound Sites and Outcomes 2 Years after Surgery

Kyoichi Matsuzaki, Akira Miyamoto, Naohiro Hakamata, Masahiro Fukuda, Yasutaka Yamauchi, Takako Akita, Ryoji Kuhara, Shingo Tezuka and Masaru Shiigai

Introduction: When hemodialysis patients with diabetic nephropathy develop wounds on their feet, serious complications can occur. It is important to prevent wounds in those patients. In particular, a thorough follow-up is necessary for patients with a high risk of suffering a wound.

Patients and methods: Our study examined 26 patients with wounds confined to their toes for which percutaneous transluminal angioplasty and subsequent toe amputation were performed. The patients were able to ambulate after their wounds healed and therapeutic footwear was made. This study examined the outcomes 2 years after surgery, locations of amputated toes, and patients’ history of coronary intervention.

Results and Discussion: The 26 patients consisted of 20 men (64.4 ± 10.2 years) and 6 women (74.8 ± 10.6 years), indicating a significantly higher age in women. There was a history of coronary intervention in 15 of 26 patients. Toe amputation consisted of the first toe in 13 toes, the second toe in 8 toes, the third toe in 3 toes, the fourth toe in 4 toes, and the fifth toe in 8 toes. There were significantly more first toes than other toes. There were 19 patients with only 1 affected toe. In these patients, the first toe was the most commonly affected toe, followed by the fifth toe. The outcomes 2 years after surgery were survival in 17 patients and death in 9 patients. The mean age was 64.2 years in patients who survived and 71.7 years in patients who died. Seven of nine patients who died had a history of coronary intervention. Of the 17 patients who survived, 6 patients had re-amputation within 2 years after initial surgery. Five of the six re-amputation cases involved toe amputation on the ipsilateral foot. Thus, a thorough follow-up is necessary if there is continued burden on the foot with surgery.