Operation Techniques and Outcomes in Patients with Chronic Limb Threatening Ischaemia Undergoing Minor Amputations—A Cohort Study

Abstract

Introduction

For patients with chronic limb threatening ischaemia (CLTI), minor amputations are frequently performed; however, evidence regarding surgical technique and outcomes is limited. This study aimed to investigate the association between toe amputation technique and clinical outcomes.

Method

A retrospective cohort study was conducted, including all patients with Rutherford 5 or 6 CLTI who underwent a toe amputation at a single university centre between January 2018 and December 2023. Data were extracted from electronic patient records. Surgical techniques included metatarsophalangeal disarticulation, metatarsophalangeal disarticulation with cartilage removal, and transmetatarsal ray decapitation. Primary outcomes were wound healing status at 30 days after the procedure and time to wound healing. Secondary outcomes included complications, length of stay, additional interventions, additional amputations, and overall mortality rate.

Results

One hundred and seventy-eight patients were included, with a median age of 72.2 years. Wound healing at 30 days and median time to wound healing were not associated with amputation technique (overall healing rate 68.0%, p = 0.16; median healing time eighty-three days (interquartile range 31.3, 146.3 days), p = 0.21). In multivariable analysis, toe pressure < 30 mmHg, diabetes mellitus, and procedures performed in an acute setting were independently associated with non-healing at 30 days. Overall, 34.3% of patients underwent additional revascularisation and 30.9% required a subsequent minor or major amputation. During a median follow up of 1.6 years, 91 patients (43.1%) died.

Conclusion

The toe amputation technique was not associated with wound healing outcomes in CLTI. Clinical decision making should prioritise optimisation of vascular status and patient specific factors over the choice of amputation technique alone.