The outcomes of toe amputations in diabetic patients: a 5-year follow-up study

Objective To observe the outcomes of toe amputations in diabetic patients and to analyze the affecting factors.Methods Two-hundred and forty-five patients were divided into 2 groups:202 cases with the wound healed after toe amputation,and 43 patients whose wound did not heal after toe amputation.The factors related to healing were analyzed.Patients with healed wounds after toe amputations ( n =202 ) were followed,regarding reappearance of new ulcers,reamputations,mortality,activities of daily life,and the affecting factors.Results The rate of wound healing was 82.4％.The rate of follow-up in the healed group was 91.6％.The rates of reappearance of new ulcers after 1,3,and 5 years of observation were 27.3％,57.2％,76.4％,respectively.The rates of reamputations after 1,3,and 5 years of observation were 17.5％,22.3％,47.1％,respectively.The mortality rates by 1,3,and 5 years after the toe amputations were 3.8％,15.1％,32.7％,respectively.Mean survival time of the fatal cases after the first amputation was 3.8 (95％ CI 3.4-4.1 )years.Multivariate analysis showed that HbA1c (＞9％)was an independent predictor of wound healing,reappearance of new ulcers,and reamputations after toe amputations,and age ( ＞ 70 years ) was an independent predictor of reamputations,mortality,and hampered daily activities.Conclusion Despite a satisfactory initial healing process after the first amputation,the long-term outcomes of the followed-up patients are not optimistic.Senile patients are often with poor prognosis,and good blood glucose control may improve the prognosis. Key words: Diabetic foot; Ulcer; Toe amputations; Mortality