A Retrospective Cohort Study Of Two Different Plane Amputations In Diabetic Foot

Objective To observe and compare the clinical efficacy of Reserved proximal phalangeal amputation(RPPA)combined with negative pressure wound therapy(NPWT)and Metatarsophalangeal joint amputation(MJA)combined with NPWT in the treatment of diabetic foot toe ulcer.To analyze the short-term clinical efficacy and long-term prognosis of preserve partial phalangeal amputation,and provide new ideas for reducing the amputation rate,recurrence rate,and amputation level of diabetic foot.Data and Methods A total of 60 eligible patients with diabetic foot and toe ulcers admitted to the Department of Burns and Plastic Surgery,Jiangsu North People’s Hospital from February 2015 to December 2019 were collected,and retrospective analysis and summary of clinical data.Two groups were set up,including(1)RPPA+NPWT group(n=25):Reserved proximal phalangeal amputation and negative pressure wound therapy covers wounds in phase I surgery,and phase II surgery for debridement and suture.(2)MJA+NPWT group(n=35):Metatarsophalangeal joint amputation and negative pressure wound therapy covers wounds in phase I surgery,and phase II surgery for debridement and suture.Both groups were treated with blood glucose control,local and systemic anti-infective treatment during the treatment period.,Follow-up 3 to 12 months after operation and comparative analysis.the test indices including:1)time duration from phase I to phase II;Duration of Phase II Surgery to Discharge;Total length of in the hospital in both RPPA+NPWT group and MJA+NPWT group;2)Volume of drainage after phase I surgery;3)Wound healing;4)Ulcer recurrence or metastatic ulcer causes secondary hospitalization;5)rehospitalized patients undergo further surgery;6)results of wound bacterial culture;7)complications.Statistical analysis of data using SPSS 23.0 software.Results(1)The time duration from phase I operation to phase II;interval between Phase II Surgery and Discharge;the total length of in the hospital in both RPPA+NPWT group and MJA+NPWT group The time duration from phase I to phase II:RPPA+NPWT group time interval about 6.5-8.0 days and the MJA+NPWT group time interval about 6.0-8.0 days,Regardless of the choice of the truncated plane,the growth time of wound granulation is similar.There was no significant difference between the two groups(P>0.05).But in the duration of Phase II Surgery to Discharge time and Total length of in the hospital results: the time duration in the RPPA+NPWT group was significantly shorter than in the MJA+NPWT group(5.0-10.0 VS 9.0-13.0 and 22.16±7.11 VS 27.17±7.16),The difference between the two groups was statistically significant(P<0.05).(2)Volume of drainage after phase I surgery the drainage volume of RPPA+NPWT group was significantly less than that of MJA+NPWT group(10.0-32.5ml VS 20.0-80.0ml).The difference between the two groups is statistically significant(P<0.05).(3)Wound healing Incision healing was evaluated according to the level of incision healing.In the RPPA+NPWT group grade A:17 cases;grade B:6 cases;grade C:2 cases;In the MJA+NPWT group grade A :15 cases;grade B&C : 20 cases。Percent of patients with Grade A healing in the PRRA group were more than those in the MJA group(68% VS 43%)(4)Ulcer recurrence or metastatic ulcer causes secondary hospitalization Observed from the percentage of rehospitalization and Kaplan-Meier survival curve analysis showed that the rehospitalization trend of patients in the MJA+NPWT group was more significant than that in the RPPA+NPWT group,but the difference between the two groups was not statistically significant(P>0.05).Consider here that a small sample size leads to this result(5)rehospitalized patients undergo further surgery Among the patients who were readmitted,one patient in the RPPA+NPWT group underwent metatarsophalangeal joint amputation,and three patients improved after conservative treatment;Ten patients in the MJA+NPWT group underwent surgery,of which 3 patients underwent skin grafting and 6 cases underwent amputation due to ulcers or necrosis near the toes,1 patient underwent half palm amputation,the remaining 1 case improved after conservative treatment.The difference between the two groups is statistically significant(P<0.05).(6)Results of wound bacterial culture The number of patients with positive culture results in the RPPA+NPWT group(2)was not significantly different from the MJA+NPWT group(6)(7)Complication: Toe deformity or stump pain There were no stump pain in 60 patients in the two groups during follow-up.There were significantly more toe deformities in the MJA+NPWT group(15)than in the RPPA+NPWT group(2),The difference between the two groups is statistically significant(P<0.05).Conclusion Reserved proximal phalangeal amputation can shorten the total number of hospital stays and significantly reduce the NPWT drainage after operation.According to the KM survival curve,the incidence of ulcer recurrence or metastatic ulcers has decreased significantly.Postoperative follow-up showed that the incidence of toe deformities decreased significantly.Reserved proximal phalangeal amputation follows the principle of retaining the length of the affected limb as much as possible,reduces the formation of dead space at the end of the toe,on the other hand,it can not only maintain the weight-bearing function of the foot,but also reduce the occurrence of dislocation of the joints near the toe,which reduces the toe Incidence of malformations,reduce the psychological burden and further improve the quality of life of patients.It is feasible in clinical application.