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KMID : 1144920180140020068
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Journal of Wound Management and Research
2018 Volume.14 No. 2 p.68 ~ p.73
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Modified Toe Amputation Reduces Hematoma Rate in Diabetic Foot Ulcer
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Leem Soo-Seong
Chang Jung-Woo
Choi M. Seung-Suk
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Abstract
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Background: One of the common methods to perform toe amputation is the enucleation of the toe at the metatarsophalangeal joint. The level of the web space skin is far more distal than the amputation level; hence, a dead space is inevitably formed between the level of skin closure and the metatarsophalangeal joint, which is prone to hematoma formation. We describe a method to amputate the toe at the proximal phalanx, just proximal to the web space skin, that prevents dead space formation and potentially reduces the hematoma rate.
Methods: Eleven patients with diabetic foot ulcers had a toe amputation just proximal to the level of the web space skin. After creation of a small flap for closure, the proximal phalanx was amputated approximately 2?3 mm proximal to the level of the web space skin. The skin flap was closed in a primary or delayed fashion depending on the infection status. Two patients underwent the operation without discontinuing anti-platelet medication. Follow-up loss occurred in one case.
Results: None of the patients showed hematoma formation. One patient underwent additional amputation due to residual infection. All the other patients healed primarily without any additional revision or surgery of the amputated toe.
Conclusion: The described toe amputation technique at the level of the web space skin prevents dead space formation, which can occur after toe enucleation at the metatarsophalangeal joint, thus inhibits hematoma formation.
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KEYWORD
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Diabetic foot, Amputation, Toes, Hematoma
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