From the Guidelines
Dorsal foot closure amputation should be considered for patients with severe foot infections, gangrene, or trauma, where more conservative treatments have failed, and the goal is to preserve as much healthy tissue as possible while removing the affected area. This approach is supported by the 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections 1. The guideline emphasizes the importance of surgical consultation for patients presenting with clinical evidence of a life- or limb-threatening infection, and notes that the absence of fever or leukocytosis should not dissuade the clinician from considering surgical exploration of a diabetic foot infection.
When considering dorsal foot closure amputation, it is essential to evaluate the patient's overall condition, including the presence of ischemia, and to involve a surgical specialist with experience in foot anatomy and the pathophysiology of diabetic foot infections 1. The procedure should be performed in a manner that preserves as much of the limb as possible, while also considering vascular, reconstructive, and rehabilitation issues 1. Post-operatively, patients should receive appropriate pain management, wound care, and physical therapy to maintain strength and mobility.
Key considerations for dorsal foot closure amputation include:
- Proper patient selection, based on the severity of the infection or condition, and the presence of adequate blood supply to ensure healing 1
- Meticulous surgical technique, to minimize the risk of complications and promote optimal healing 1
- Comprehensive post-operative care, including offloading the surgical site during healing, to prevent further complications and promote recovery 1
- The use of prophylactic antibiotics, such as cefazolin 1-2g IV, before and after surgery, to reduce the risk of infection 1
- The importance of monitoring for signs of infection, such as redness, warmth, drainage, and increased pain, and taking prompt action if any of these signs are observed 1
From the Research
Dorsal Foot Closure Amputation
- The provided studies do not directly address dorsal foot closure amputation, but rather focus on lower extremity amputations and the use of various anesthesia techniques and wound therapies.
- However, some studies discuss the importance of preoperative evaluation and postoperative care in reducing complications for lower extremity amputations 2, 3.
- The use of closed incision negative pressure wound therapy (NPWT) has been shown to decrease wound complications in major lower extremity amputations 2.
- Regional anesthesia has been associated with reduced postoperative morbidity and mortality in patients undergoing lower extremity amputation 4, 5, 6.
- The choice of anesthesia technique, such as general anesthesia or peripheral nerve block, can impact postoperative outcomes, including the risk of complications and the need for vasopressors 5, 6.
Anesthesia Techniques
- Regional anesthesia, including spinal anesthesia and peripheral nerve block, has been shown to reduce postoperative analgesic requirements and complications in patients undergoing lower extremity amputation 4, 5, 6.
- General anesthesia has been associated with a higher risk of postoperative complications, including pneumonia, acute kidney injury, and total major complications 6.
- The use of peripheral nerve block (PNB) has been shown to be protective against complications following lower extremity amputation in diabetes patients with coagulopathy 6.
Wound Therapy
- Closed incision NPWT has been shown to decrease the incidence of wound complications in vascular patients undergoing major lower extremity amputation 2.
- The use of NPWT has been associated with fewer wound complications, including wound dehiscence, superficial surgical site infections, and incision line necrosis 2.