PDF
ePub
Citation
Print
Abstract
Purpose:
The purpose of this study is to evaluate the incidence and cause of reamputation with respect to the location of foot amputation.
Materials and Methods:
Eighty-six patients who received amputations below the ankle level from March 2002 to September 2012 with at least 1 year follow-up were enrolled in this study. We stratified the site of the initial amputation from first to fifth ray and into either the phalanx or metatarsal bone, and investigated the cause of reamputation.
Results:
The reamputation rate below the ankle level was 53.5%. It was highest (62.1%) in patients with first ray amputations without statistical significance. Rays were divided into two columns, first to third rays as the medial column and others as the lateral column, and reamputation was performed in 61.2% of patients with medial column amputation. Comparing the results between phalanx and metatarsal amputations, reamputation was performed in 62.1% of patients with metatarsal bone amputation. The rate of reamputation was statistically significant in both the medial column and metatarsal amputations. The most common reamputation site, in accordance to the initial site of amputation, was the adjacent ray (57.4%), which was without statistical significance. Moreover, the most common cause of reamputation was osteomyelitis and focal infection in all rays.
Conclusion:
This study showed that reamputation after amputation below the ankle level was relatively common with highest rate in medial column and metatarsal amputations. Hence, surgeons should be aware of the risk of reamputation and put more preventive effort during medial column and metatarsal amputations.
Go to : 
REFERENCES
1.Nerone VS., Springer KD., Woodruff DM., Atway SA. Reamputation after minor foot amputation in diabetic patients: risk factors leading to limb loss. J Foot Ankle Surg. 2013. 52:184–7.
2.Murdoch DP., Armstrong DG., Dacus JB., Laughlin TJ., Morgan CB., Lavery LA. The natural history of great toe amputations. J Foot Ankle Surg. 1997. 36:204–8.
3.Izumi Y., Satterfield K., Lee S., Harkless LB. Risk of reamputation in diabetic patients stratified by limb and level of amputation: a 10-year observation. Diabetes Care. 2006. 29:566–70.
4.Jung HG., Kim YJ., Shim SH., Kim HJ. Analysis of the risk factors for lower extremity amputation due to diabetic foot complications. J Korean Foot Ankle Soc. 2007. 11:149–53.
5.Armstrong DG., Lavery LA., van Houtum WH., Harkless LB. The impact of gender on amputation. J Foot Ankle Surg. 1997. 36:66–9.
6.Lavery LA., Ashry HR., van Houtum W., Pugh JA., Harkless LB., Basu S. Variation in the incidence and proportion of diabetes-related amputations in minorities. Diabetes Care. 1996. 19:48–52.
7.Armstrong DG., Lavery LA., Quebedeaux TL., Walker SC. Surgical morbidity and the risk of amputation due to infected puncture wounds in diabetic versus nondiabetic adults. South Med J. 1997. 90:384–9.
8.Armstrong DG., Lavery LA. Plantar pressures are higher in diabetic patients following partial foot amputation. Ostomy Wound Manage. 1998. 44:30–2. 34, 36 passim.
9.Lavery LA., Lavery DC., Quebedeax-Farnham TL. Increased foot pressures after great toe amputation in diabetes. Diabetes Care. 1995. 18:1460–2.
10.Schulte L., Roberts MS., Zimmerman C., Ketler J., Simon LS. A quantitative assessment of limited joint mobility in patients with diabetes. Goniometric analysis of upper extremity passive range of motion. Arthritis Rheum. 1993. 36:1429–43.
11.Rosenbloom AL., Silverstein JH., Lezotte DC., Richardson K., Mc-Callum M. Limited joint mobility in childhood diabetes mellitus indicates increased risk for microvascular disease. N Engl J Med. 1981. 305:191–4.
12.Oxlund H., Andreassen TT. Aminoguanidine treatment reduces the increase in collagen stability of rats with experimental diabetes mellitus. Diabetologia. 1992. 35:19–25.
13.Alcolado JC., Pacy PJ., Beevers M., Dodson PM. Risk factors for peripheral vascular disease in hypertensive subjects with type 2 diabetes mellitus. Diabet Med. 1992. 9:904–7.
14.Vogt MT., Wolfson SK., Kuller LH. Lower extremity arterial disease and the aging process: a review. J Clin Epidemiol. 1992. 45:529–42.
15.Melton LJ 3rd., Macken KM., Palumbo PJ., Elveback LR. Incidence and prevalence of clinical peripheral vascular disease in a population-based cohort of diabetic patients. Diabetes Care. 1980. 3:650–4.
16.Beach KW., Strandness DE Jr. Arteriosclerosis obliterans and associated risk factors in insulin-dependent and non-insulin-dependent diabetes. Diabetes. 1980. 29:882–8.
17.Malarcher AM., Ford ES., Nelson DE., Chrismon JH., Mowery P., Merritt RK, et al. Trends in cigarette smoking and physicians’ advice to quit smoking among people with diabetes in the U.S. Diabetes Care. 1995. 18:694–7.
18.Franklin GM., Kahn LB., Baxter J., Marshall JA., Hamman RF. Sensory neuropathy in non-insulin-dependent diabetes mel-litus. The San Luis Valley Diabetes Study. Am J Epidemiol. 1990. 131:633–43.
19.Bloch S., Rosenthal AR., Friedman L., Caldarolla P. Patient compliance in glaucoma. Br J Ophthalmol. 1977. 61:531–4.
Go to :
Table 1.
Location of Single-Ray and Multi-Ray
Table 2.
Comparison between Amputation Group and Reamputatio Group
Table 3.
Comparison between Groups according to Location of Ray Amputation
Table 4.
Comparison between Metatarsal Amputation Group and Phalanx Amputation Group
Table 5.
Comparison between Medial Column (1st, 2nd, 3rd Ray) Amputation Group and Lateral Column (4th, 5th Ray) Amputation Group
Table 6.
Comparison between Single-Ray Amputation Group and Multi-Ray Amputation Group
XML Download