Minimum-incision Metatarsal Ray Resection: An Observational Case Series

Abstract 

This report describes the results of 17 metatarsal ray resections performed through a minimal incision in 13 consecutive patients. Each patient underwent minimum-incision metatarsal ray resection for either definitive treatment or as the index incision and drainage procedure followed by transmetatarsal amputation. There were 10 male and 3 female patients with a mean age of 68.8 ± 8.5 years (range, 59-83 years). Twelve patients had diabetes mellitus and 7 had critical limb ischemia. There were 11 right feet and 6 left feet involved, and 3 second, 3 third, 3 fourth, and 8 fifth minimum-incision metatarsal ray resections performed. Direct primary-incision closure was performed 7 times (1 with adjacent percutaneous metatarsal osteotomy), delayed primary closure was performed 4 times (1 with external fixation), and conversion to a transmetatarsal amputation was performed 2 times. Fourteen of 17 minimum-incision metatarsal ray resections were deemed successful. Two failures occurred when skin necrosis developed from excessive tension along the incision line requiring conversion to a transmetatarsal amputation, and the other occurred in a patient with unreconstructed critical limb ischemia who underwent multiple repeated incision and drainage procedures and vascular bypass with ultimate healing via secondary intent. When properly performed in patients with adequate vascular inflow, minimum-incision metatarsal ray resection as the definitive procedure or in conjunction with an incision and drainage for unsalvageable toe infection or gangrene represents a safe, simple, useful technique.

Level of Clinical Evidence: 4

Keywords: amputation, diabetes, limb salvage, minimally invasive surgery, ulcer