Toe amputation effective in diabetics

Transmetatarsal amputation (TMA) appears to be an effective approach in diabetes management and can help avoid lower-extremity amputations (LEA), a recent study has found. However, patient-related factors such as insulin dependence and serum albumin affect the procedure’s efficacy.

Researchers performed a retrospective assessment of 81 diabetic patients who underwent TMA between January 2017 and 2019. Around half (50.6 percent; n=41) of participants reached complete healing. Most (85.2 percent) of them were insulin-dependent, and nearly half (45.7 percent) had severe ankle-brachial index (ABI).

Compared with their healed counterparts, peripheral artery disease was significantly more common among patients who remained unhealed (71.0 percent vs 46.3 percent; p=0.037). The same was true for those who underwent prior revascularization (51.6 percent vs 26.8 percent; p=0.031). In contrast, a normal ABI was more common among healed patients (24.4 percent vs 6.5 percent; p=0.006).

Multivariant analysis showed that those who were insulin-dependent were significantly more likely to experience failed TMA (odds ratio [OR], 482.5; p=0.023). The same was true for low serum albumin (OR, 282.9; p=0.004) and high C-reactive protein (OR, 162.5; p=0.015).

Similarly, those who were insulin-dependent were significantly more likely to progress to major LEA (OR, 1.5×10⁴; p=0.02), as were those with low albumin (OR, 300.7; p=0.033).

“In patients with an increased risk of failure, such as those with severe ischaemia and unreconstructible vessels, definitive major LEA should be prudently considered to avoid inevitable failures,” the researchers said.