PREDICTORS OF OUTCOME OF FOREFOOT SURGERY FOR ULCERATION AND GANGRENE

BACKGROUND: Surprisingly little is known about the long-term outcome o f forefoot surgery for limb salvage. METHODS: From January 1, 1992 thr ough December 31, 1996, patients requiring toe amputation or forefoot surgery were prospectively entered into a computerized database and fo llowed up for healing, need for repeat foot surgery, or major amputati on (below or above knee). RESULTS: A total of 162 patients (mean age 6 5 years), 72% diabetic, 10% with end-stage renal disease (ESRD), and 7 3% without palpable pulses, were entered into the study. Mean follow-u p was 25 months. Of patients without palpable pulses (n = 98), 83% und erwent concomitant or subsequent limb revascularization. Eleven of 98 revascularization procedures (11%) were hemodynamically unsuccessful. Nonhealing of the initial forefoot procedure occurred in 14%, and late repeat foot surgery (following initial healing) was required in an ad ditional 14%. Major amputation was eventually required in 30 (18.5%) p atients. Multivariate analysis indicated that unsuccessful revasculari zation, but not diabetes or ESRD, predicted nonhealing and major amput ation (P <0.0001). Patients presenting with palpable pulses and neurop athic ulcers were at risk for late, repeat foot surgery, but not major amputation (P = 0.0015). CONCLUSIONS: In patients requiring toe or pa rtial forefoot amputation, success of revascularization is the primary predictor of initial healing and freedom from major amputation. Neuro pathic ulceration predicts need for repeat foot surgery following heal ing. (C) 1998 by Excerpta Medica, Inc.