Outcomes of Diabetic Toe Amputation With Versus Without Metatarsal Head Resection for Single Ray Wet Gangrene: A Preliminary Study

ABSTRACT Background Diabetic wet gangrene of the toes is a serious condition that puts at risk the limb and life of patients. Two types of amputation are used when infection is around the metatarsophalangeal joint (MTPJ): complete toe disarticulation and toe amputation including metatarsal head rese...

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Main Authors: Kaissar Yammine, Mohammad Honeine, Joseph Mouawad, Ghadi Abou Orm, Youssef Jamaleddine, Chahine Assi
Format: Article
Language:English
Published: Wiley 2025-06-01
Series:Journal of Foot and Ankle Research
Subjects:
Online Access:https://doi.org/10.1002/jfa2.70052
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author Kaissar Yammine
Mohammad Honeine
Joseph Mouawad
Ghadi Abou Orm
Youssef Jamaleddine
Chahine Assi
author_facet Kaissar Yammine
Mohammad Honeine
Joseph Mouawad
Ghadi Abou Orm
Youssef Jamaleddine
Chahine Assi
author_sort Kaissar Yammine
collection DOAJ
description ABSTRACT Background Diabetic wet gangrene of the toes is a serious condition that puts at risk the limb and life of patients. Two types of amputation are used when infection is around the metatarsophalangeal joint (MTPJ): complete toe disarticulation and toe amputation including metatarsal head resection. Because very few published papers analyzed the results of toe amputation for wet gangrene, our study aimed to evaluate the outcomes of both techniques. Methods This is a retrospective comparative study of highly selective patients admitted for a single toe/ray diabetic wet gangrene that were treated with toe amputation through MTPJ (TA‐MTPJ) versus toe amputation with resection of the metatarsal head (TA‐MHR). Three primary outcomes were set for analysis: healing rate and the frequencies of infection recurrence and additional surgeries, including reamputations. Results The sample included 31 cases: 12 cases (39%) with TA‐MTPJ and 19 cases (61%) with TA‐MHR. Outcomes of TA‐MTPJ versus TA‐MHR were as follows: (a) healing frequency 66.7% versus 58% (p = 0.6), (b) infection recurrence 50% versus 52.6% (p = 0.8), (c) osteomyelitis 41.6% versus 42.1% (p = 0.8), and (d) reamputation 33.3% versus 47.3% (p = 0.4). Conclusions This study showed high complications after toe amputation for diabetic digital wet gangrene, with a trend for higher frequency of complications after TA‐MHR compared to TA‐MTPJ. For any type of amputation required for toe wet gangrene, it is likely that a more proximal level of index amputation is required.
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spelling doaj-art-7286fdb167264166baed552cb612f80e2025-08-20T03:26:53ZengWileyJournal of Foot and Ankle Research1757-11462025-06-01182n/an/a10.1002/jfa2.70052Outcomes of Diabetic Toe Amputation With Versus Without Metatarsal Head Resection for Single Ray Wet Gangrene: A Preliminary StudyKaissar Yammine0Mohammad Honeine1Joseph Mouawad2Ghadi Abou Orm3Youssef Jamaleddine4Chahine Assi5Department of Orthopedic Surgery Lebanese American University Medical Center‐Rizk Hospital School of Medicine Lebanese American University Beirut LebanonDepartment of Orthopedic Surgery Lebanese American University Medical Center‐Rizk Hospital School of Medicine Lebanese American University Beirut LebanonDepartment of Orthopedic Surgery Lebanese American University Medical Center‐Rizk Hospital School of Medicine Lebanese American University Beirut LebanonDepartment of Orthopedic Surgery Lebanese American University Medical Center‐Rizk Hospital School of Medicine Lebanese American University Beirut LebanonDepartment of Orthopedic Surgery Lebanese American University Medical Center‐Rizk Hospital School of Medicine Lebanese American University Beirut LebanonDepartment of Orthopedic Surgery Lebanese American University Medical Center‐Rizk Hospital School of Medicine Lebanese American University Beirut LebanonABSTRACT Background Diabetic wet gangrene of the toes is a serious condition that puts at risk the limb and life of patients. Two types of amputation are used when infection is around the metatarsophalangeal joint (MTPJ): complete toe disarticulation and toe amputation including metatarsal head resection. Because very few published papers analyzed the results of toe amputation for wet gangrene, our study aimed to evaluate the outcomes of both techniques. Methods This is a retrospective comparative study of highly selective patients admitted for a single toe/ray diabetic wet gangrene that were treated with toe amputation through MTPJ (TA‐MTPJ) versus toe amputation with resection of the metatarsal head (TA‐MHR). Three primary outcomes were set for analysis: healing rate and the frequencies of infection recurrence and additional surgeries, including reamputations. Results The sample included 31 cases: 12 cases (39%) with TA‐MTPJ and 19 cases (61%) with TA‐MHR. Outcomes of TA‐MTPJ versus TA‐MHR were as follows: (a) healing frequency 66.7% versus 58% (p = 0.6), (b) infection recurrence 50% versus 52.6% (p = 0.8), (c) osteomyelitis 41.6% versus 42.1% (p = 0.8), and (d) reamputation 33.3% versus 47.3% (p = 0.4). Conclusions This study showed high complications after toe amputation for diabetic digital wet gangrene, with a trend for higher frequency of complications after TA‐MHR compared to TA‐MTPJ. For any type of amputation required for toe wet gangrene, it is likely that a more proximal level of index amputation is required.https://doi.org/10.1002/jfa2.70052diabetic foot infectiondiabetic foot ulcerosteomyelitistoe amputationwet gangrene
spellingShingle Kaissar Yammine
Mohammad Honeine
Joseph Mouawad
Ghadi Abou Orm
Youssef Jamaleddine
Chahine Assi
Outcomes of Diabetic Toe Amputation With Versus Without Metatarsal Head Resection for Single Ray Wet Gangrene: A Preliminary Study
Journal of Foot and Ankle Research
diabetic foot infection
diabetic foot ulcer
osteomyelitis
toe amputation
wet gangrene
title Outcomes of Diabetic Toe Amputation With Versus Without Metatarsal Head Resection for Single Ray Wet Gangrene: A Preliminary Study
title_full Outcomes of Diabetic Toe Amputation With Versus Without Metatarsal Head Resection for Single Ray Wet Gangrene: A Preliminary Study
title_fullStr Outcomes of Diabetic Toe Amputation With Versus Without Metatarsal Head Resection for Single Ray Wet Gangrene: A Preliminary Study
title_full_unstemmed Outcomes of Diabetic Toe Amputation With Versus Without Metatarsal Head Resection for Single Ray Wet Gangrene: A Preliminary Study
title_short Outcomes of Diabetic Toe Amputation With Versus Without Metatarsal Head Resection for Single Ray Wet Gangrene: A Preliminary Study
title_sort outcomes of diabetic toe amputation with versus without metatarsal head resection for single ray wet gangrene a preliminary study
topic diabetic foot infection
diabetic foot ulcer
osteomyelitis
toe amputation
wet gangrene
url https://doi.org/10.1002/jfa2.70052
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