Diabetic foot infection severity as a predictor of re-ulceration following partial forefoot amputation.

Abstract

Diabetic foot ulcer re-ulceration is a common complication following partial forefoot amputation. Re-ulceration refers to the occurrence of a skin break that penetrates through the epidermis and a portion of the dermis, occurring at any site on either the same or opposite foot where amputation took place. Treatment for diabetic foot ulcers often includes an extended course of local wound care and may entail surgical procedures. The aim of this study was to evaluate the incidence of re-ulceration in people who underwent a partial forefoot amputation. We hypothesized there is an association between amputation type and occurrence of re-ulceration. A retrospective chart review was performed for 253 individuals between December 2015 and September 2020. One hundred eleven people met eligibility criteria and were divided into two cohorts: those who re-ulcerated and those who did not. Univariable analysis was performed for available demographic, clinical, laboratory and outcome data. Seventy-nine of the 111 (71.2 %) subjects re-ulcerated status post partial forefoot amputation. Based on the Infectious Disease Society of America (IDSA) classification for assessment of infection, the average severity for the re-ulceration group was 2.62, while for the no re-ulceration group was 2.22 (p < 0.001). The median time to re-ulceration was 186 days. No association was demonstrated between amputation location and incidence of re-ulceration. Patients with higher diabetic foot infection severity based on IDSA classification are at greater risk for developing re-ulceration following a partial forefoot amputation. LEVEL OF CLINICAL EVIDENCE: : 3.