Abstract
Medical literature offers no clear treatment guidelines when performing amputations
for gangrene of the forefoot despite a high percentage that suffer poor outcome due
to infection. Gas gangrene and wet gangrene are often preceded by dry stable gangrene.
This is a retrospective review of consecutive patients who underwent forefoot amputation
and bone biopsy as treatment of forefoot gangrene by a single surgeon. Procedures
performed included digital, ray, or transmetatarsal amputation with bone biopsy sent
for both culture and histopathologic evaluation. One hundred patients (35 females,
65 males) met inclusion criteria. Mean follow-up was 9.6 months. Mean age was 63.5
years old. Forty-six out of 100 (46%) had elective amputation while 54/100 (54%) were
emergent for acute infection. Vascular intervention was performed in 52/100 (52%).
Seventy-eight out of 100 (78%) had histopathologic diagnosis of acute osteomyelitis
while 82/100 (82%) had positive bone culture. Patients with acute infection had worse
outcomes, with higher rates of more proximal amputation and delayed wound healing.
We found that 79.7% of patients who underwent forefoot amputation due to gangrene
had underlying osteomyelitis. We also found that those with acute infection during
the time of amputation had poorer postamputation outcomes such as delayed wound healing,
revision surgery, and high rates of more proximal amputation. Therefore, it may imply
that earlier amputation of stable gangrene prior to becoming acutely infected may
decrease the occurrence of osteomyelitis and avoid some of the preventable postamputation
complications. Further studies are warranted.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: August 11, 2021
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
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© 2021 by the American College of Foot and Ankle Surgeons. All rights reserved.
