1486-PUB: Single-Toe Necrosis over Diabetic Foot Ulcer (DFU) : Amputation Surgery at Bedside by a Diabetologist or in the Operating Room by a Surgeon

Single toe necrosis complicating DFU requires an amputation performed in the operating room by a surgeon (ORAS) . Bedside amputation by a diabetologist (BAD) complying with the surgical rules might be an option in case of disagreement with the surgeon about the amputation level (major favored by the surgeon) and/or an anesthetic contraindication. In our monocentric, retrospective study, we assessed the one year prognosis (healing rate without extra surgery) of a single toe necrosis amputation over DFU performed by a diabetologist or a surgeon. Amputation levels (transphalangeal, TPA, metatarsophalangeal disarticulation, MPD, single transmetatarsal, TMA) were decided by our multidisciplinary team. Out of 7patients admitted with DFU (05.2016-10.2020) , 57 (8%) were included because of single toe necrosis (BAD n=33, 58%; ORAS n=24, 42%) . Amputation levels TPA, MPD, TMA were respectively 26, 47, 27%. The median duration of follow-up was 28 months. Patients characteristics were non statistically different between groups except for the dorsal arch permeability: males 74%; median age 64y; Type 2 Diabetes Mellitus (DM) 97%; median DM duration 17y. The rate of permeable dorsal arch was significantly lower in the BAD group (45% vs. 75%, p=0.03) . Single TMA rate was significantly higher in the ORAS group (50% vs. 9%, p=0.001) . The one year healing rate without extra surgery was statistically different between the two groups (BAD 58% vs. ORAS 83%, p=0.05) . The need for extra surgery was significantly higher in the BAD group (42% vs. ORAS 13%, p=0.02) . The overall mortality was non significantly different between groups (BAD 21% vs. ORAS 4%, p=0.12) . For a single toe necrosis over DFU, in patients with a high risk for a circumscribed toe amputation failure as stated by the surgeon, the results of bedside amputation performed by a diabetologist invalidated this unfavorable prognosis in most cases.