Clinical outcomes of toe amputation in patients with type 2 diabetes in Tianjin, China

• Published in: International wound journal Vol. 13; no. 2; pp. 175 - 181
• Main Authors: Chu, Yue-Jie, Li, Xi-Wen, Wang, Peng-Hua, Xu, Jun, Sun, Hao-Jie, Ding, Min, Jiao, Jiao, Ji, Xiao-Yan, Feng, Shu-hong
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-04-2016
• Subjects: Activities of Daily Living; Adult; Aged; Aged, 80 and over; Amputation - methods; China - epidemiology; Diabetes Mellitus, Type 2 - complications; Diabetic foot; Diabetic Foot - epidemiology; Diabetic Foot - etiology; Diabetic Foot - surgery; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Mortality; Original; Prospective Studies; Recurrence; Toe amputation; Toes - surgery; Treatment Outcome; Ulcer; Ulcer; Toe amputation; Mortality; Diabetic foot
• ISSN: 1742-4801; 1742-481X
• DOI: 10.1111/iwj.12249

The aim of this study is to determine the predictors for reulceration, reamputation and mortality in patients with diabetes following toe amputation, and the impact of activities of daily living on clinical outcomes.
This prospective cohort study included 245 patients who had undergone toe amputation (202 healing and 43 non‐healing) and was followed for a 5‐year period. Data regarding new foot ulceration, reamputation and mortality were recorded, and the patients' activities of daily living were evaluated.
The rate of wound healing was 82·4%. The rate of follow‐up in the healed group was 91·6%. In years 1, 3 and 5, the cumulative incidence of patients who developed a new foot ulcer was 27·3%, 57·2% and 76·4%, respectively, leading to reamputation in 12·5%, 22·3% and 47·1%, respectively. The cumulative mortality was 5·8%, 15·1% and 32·7% at 1, 3 and 5 years, respectively. Multivariate analysis showed that GHbA1c > 9% (75 mmol/mol) was identified as an independent predictor of impaired wound healing, reulceration and reamputation. An age of >70 years was identified as an independent predictor of reamputation, mortality and impairment of activities of daily living.
Despite a satisfactory initial healing rate after the first toe amputation, with the extension course after the toe amputation, the long‐term outcomes are not optimistic. In developing countries like China, taking measures to prevent reulceration and reamputation is very important for patients with diabetic foot minor amputations, especially following toe amputation.