Transfer Lesions Following Met Head Resection in Diabetes: Site Matters.

foot-ulcer

Analysis of transfer lesions in patients who underwent surgery for diabetic foot ulcers located on the plantar aspect of the metatarsal heads – Molines-Barroso – Diabetic Medicine – Wiley Online Library:

Great, practical work from the team at the Complutense in Madrid and from Grand Canaria. In summary: 41% of patients reulcerated at one half year to two years postoperatively. Risk for transfer lesions highest for resections of 1st metatarsal head and lowest for the 5th.

Keywords:

  • diabetic foot;
  • foot ulcers;
  • prevention;
  • reulceration rate

Abstract

Aims

To analyse the risk of reulceration caused by the transfer of lesions in patients with diabetes, undergoing resection of at least one metatarsal head.

Methods

A total of 119 patients with diabetes from the Diabetic Foot Unit (Complutense University, Madrid, Spain), who underwent resection of at least one metatarsal head were analysed prospectively from November 2006 to December 2011 to assess reulceration in the other metatarsal head.

Results

Seven patients were excluded for being subjected to a pan-metatarsal head resection and 11 patients dropped out. During a median follow-up period of 13.1 months (range 6.1–22.8 months), 41% of patients suffered from reulcerations. Reulceration frequency in patients operated on the 1st, 2nd, 3rd, 4th, 5th and several metatarsal heads was 9 (69%), 8 (44%), 12 (52%), 2 (25%), 6 (19%) and 4 (50%) events, respectively. The Cox regression model showed hazard ratios that were significant for the location of the metatarsal resection. The first metatarsal showed the highest risk for reulceration (hazard ratio 3.307; 1.472–7.430) and the fifth metatarsal showed the lowest risk (hazard ratio 0.339; 0.138–0.832).

Conclusions

Reulceration is a frequent event following resection of a metatarsal head and should be regarded as an implicit complication of the intervention. The location of the resection determines the risk of reulceration, which is highest for patients operated on the first metatarsal head and lowest for patients operated on the fifth metatarsal head.

David G. Armstrong

Dedicated to amputation prevention, wound healing, diabetic foot, biotechnology and the intersection between medical devices and consumer electronics.

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