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
Keywords
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References
- Amputation of gangrenous toes: effect of sepsis, blood supply, and débridement on healing rates.S Afr Med J. 1983; 63: 973-975
- Ray resection in the dysvascular foot.Clin Orthop. 1984; 191: 232-234
- Transmetatarsal amputation of the toe: an analytic study of ischemic complications.Clin Anat. 1999; 12: 407-411
- Intermediate-term outcome of primary digit amputations in patients with diabetes mellitus who have forefoot sepsis requiring hospitalization and presumed adequate circulatory status.J Vasc Surg. 1999; 30: 509-517
- Amputation and reamputation of the diabetic foot.J Am Podiatr Med Assoc. 1997; 87: 255-259
- A novel technique for closing difficult diabetic cleft foot wounds with skin grafting and a ring type external fixator.Op Tech Orthop. 2006; 16: 38-43
- Amputation techniques.in: Hurley R. Seigafuse S.L. Marino-Vasquez D. Functional Reconstruction of the Foot and Ankle. Lippincott Williams & Wilkins, Philadelphia2000: 274-278
- Forefoot narrowing with external fixation for problem cleft wounds.Foot Ankle Int. 2002; 23: 433-439
- The use of mini external fixation in central forefoot amputations.J Foot Ankle Surg. 2005; 44: 307-310
- External fixator assisted immediate wound closure.Tech Foot Ankle Surg. 2006; 5: 144-149
- Ray amputation with limited incision.Foot Ankle Int. 2006; 27: 382
- Minimum incision ray resection.Clin Podiatr Med Surg. 2008; 25: 609-622
Article info
Footnotes
Disclaimer: The opinions or assertions contained herein are the private view of the author and are not to be construed as official or reflecting the views of the Department of the Army or the Department of Defense.
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
