Toe-Sparing Surgery for Neuropathic Toe Ulcers With Exposed Bone or Joint in an Outpatient Setting: A Retrospective Study. (June 2016)

• Record Type: Journal Article
• Authors: Tamir, Eran; Finestone, Aharon S.; Avisar, Erez; Agar, Gabriel
• Is Part Of: International journal of lower extremity wounds. Volume 15:Number 2(2016:Jun.)
• Page Start: 142
• Page End: 147
• Publication Date: 2016-06
• Subjects: neuropathic ulcer -- diabetic foot -- septic arthritis -- osteomyelitis; Leg -- Wounds and injuries -- Periodicals; Wounds and injuries -- Prevention -- Periodicals; Leg -- Ulcers -- Periodicals; Wound healing -- Periodicals; 617.584
• DOI: 10.1177/1534734616636311
• Languages: English
• ISSNs: 1534-7346

Abstract

The purpose of this study was to review the results of aggressive surgical debridement of neuropathic toe ulcers with exposed bone or joint. We identified patients with a single toe ulcer with exposed bone or joint that had been operated on in an outpatient setting. The surgery had included aggressive debridement and was performed using a small curette and rongeur, followed by oral antibiotic treatment at home. Success was defined as complete healing with no recurrence 6 months after full wound closure and epitheliazation was achieved. Twenty-five patients with neuropathic toe ulcers (72% male) had a total of 26 primary operations. Their mean age was 60 ± 12 years. In 22 patients, the neuropathy resulted from diabetes mellitus of 17 ± 9 years' duration. The mean ulcer duration was 6 weeks (range 1-24). The mean number of visits per patient was 6.5 (range 3-20). The ulcers closed in a median of 5 weeks (8 ± 6 weeks, range 3-24 weeks, Q1-Q3 4-10 weeks). At 6 months, 3 (11.5%) patients had needed a toe amputation for infection or necrosis that could not be controlled. None needed a major amputation or hospitalization related to the ulcer. Toe-sparing surgery is feasible and in a select population can have a high success rate (88%), even though it does dictate more dedicated patient care.