+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Prospective Analysis of Surgical Bone Margins After Partial Foot Amputation in Diabetic Patients Admitted With Moderate to Severe Foot Infections

Prospective Analysis of Surgical Bone Margins After Partial Foot Amputation in Diabetic Patients Admitted With Moderate to Severe Foot Infections

Foot and Ankle Specialist 2018: 1938640018770285

Osteomyelitis is common in diabetic foot infections and medical management can lead to poor outcomes. Surgical management involves sending histopathologic and microbiologic specimens which guides future intervention. We examined the effect of obtainment of surgical margins in patients undergoing forefoot amputations to identify patient characteristics associated with outcomes. Secondary aims included evaluating interobserver reliability of histopathologic data at both the distal-to and proximal-to surgical bone margin. Data were prospectively collected on 72 individuals and was pooled for analysis. Standardized method to retrieve intraoperative bone margins was established. A univariate analysis was performed. Negative outcomes, including major lower extremity amputation, wound dehiscence, reulceration, reamputation, or death were recorded. Viable proximal margins were obtained in 63 out of 72 cases (87.5%). Strong interobserver reliability of histopathology was recorded. Univariate analysis demonstrated preoperative platelets, albumin, probe-to-bone testing, absolute toe pressures, smaller wound surface area were associated with obtaining viable margins. Residual osteomyelitis resulted in readmission 2.6 times more often and more postoperative complications. Certain patients were significantly different in the viable margin group versus dirty margin group. High interobserver reliability was demonstrated. Obtainment of viable margins resulted in reduced rates of readmission and negative outcomes. Prognostic, Level I: Prospective.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 065442061

Download citation: RISBibTeXText

PMID: 29644884

DOI: 10.1177/1938640018770285

Related references

Rate of residual osteomyelitis after partial foot amputation in diabetic patients: a standardized method for evaluating bone margins with intraoperative culture. Journal of Foot and Ankle Surgery 51(6): 749-752, 2013

Partial foot amputation in patients with diabetic foot ulcers. Foot and Ankle International 33(9): 707-716, 2012

Assessing the Effect of Piperacillin/Tazobactam on Hematological Parameters in Patients Admitted with Moderate or Severe Foot Infections. Diabetes Therapy 9(1): 219-228, 2018

A meta-analysis of the relationship between foot local characteristics and major lower extremity amputation in diabetic foot patients. Journal of Cellular Biochemistry 2019, 2019

Shoes, orthoses, and prostheses for partial foot amputation and diabetic foot infection. Foot and Ankle Clinics 15(3): 509-523, 2010

Predictors of major lower limb amputation among type II diabetic patients admitted for diabetic foot problems. Singapore Medical Journal 56(11): 626-631, 2017

Use of NPWT with and without Soft Port technology in infected foot wounds undergoing partial diabetic foot amputation. Journal of Wound Care 24(Suppl. 9): S4-S12, 2015

Post-treatment leukocytosis predicts an unfavorable clinical response in patients with moderate to severe diabetic foot infections. Journal of Foot and Ankle Surgery 50(5): 541-546, 2012

Diabetic foot infections in the elderly: primary amputation versus 'foot-sparing surgery'. A case report. International Wound Journal 4(4): 315-321, 2007

Diabetic foot infections in older people with end-stage renal disease: primary amputation versus "foot-sparing surgery". Journal of the American Geriatrics Society 55(3): 476-477, 2007

Foot function in diabetic patients after partial amputation. Foot and Ankle International 17(1): 43-48, 1996

SIRS is valid in discriminating between severe and moderate diabetic foot infections. Diabetes Care 36(11): 3706-3711, 2015

A reliable surgical approach for the two-staged amputation in unsalvageable limb and life threatening acute progressive diabetic foot infections: tibiotalar disarticulation with vertical crural incisions and secondary transtibial amputation. Foot and Ankle Surgery 17(1): 13-18, 2011

Preservation of residual foot length in partial foot amputation: a biomechanical analysis. Foot and Ankle International 27(2): 110-116, 2006

Minor amputation and palliative wound care as a strategy to avoid major amputation in patients with foot infections and severe peripheral arterial disease. International Journal of Lower Extremity Wounds 13(3): 211-219, 2015