Great Toe Necrosis Predicts an Unfavorable Limb Salvage Prognosis
Summary: The initial location of necrosis may affect the limb salvage rate. This study of 130 patients with chronic toe ulcers or gangrene was performed to assess whether the location of initial necrosis in the toes affected limb salvage prognosis. The patients were divided into 2 groups according t...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2014-09-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/Fulltext/2014/09000/Article.7.aspx |
| _version_ | 1818689326207205376 |
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| author | Hitomi Sano, MD, PhD Shigeru Ichioka, MD, PhD |
| author_facet | Hitomi Sano, MD, PhD Shigeru Ichioka, MD, PhD |
| author_sort | Hitomi Sano, MD, PhD |
| collection | DOAJ |
| description | Summary: The initial location of necrosis may affect the limb salvage rate. This study of 130 patients with chronic toe ulcers or gangrene was performed to assess whether the location of initial necrosis in the toes affected limb salvage prognosis. The patients were divided into 2 groups according to whether the initial necrosis was in the great toe or in other toes. Limb salvage prognosis was determined retrospectively. In the great toe group, the rates of total toe loss and major amputation were 50.0% and 24.4%, respectively. When the initial necrosis was in other toes, these rates were 27.3% and 9.3%, respectively. Great toe necrosis is associated with significantly higher rates of total toe loss (odds ratio = 3.10; P = 0.003; 95% confidence interval, 1.43−6.68) and major amputation (odds ratio = 3.66; P = 0.007; 95% confidence interval, 1.37−9.79). The great toe is supplied by 3 source arteries, whereas the lesser toes are fed by 1 or 2 arteries. Therefore, necrosis initiating from the great toe may reflect the presence of severe vascular disorders. The great toe is also anatomically connected to much of the foot via the tendons. Infection is more likely to spread along these tendons, which may reduce limb prognosis. Thus, the initial location of necrosis may be predictive of limb prognosis. |
| first_indexed | 2024-12-17T12:08:19Z |
| format | Article |
| id | doaj.art-df299179f7a749f9b2fcef757cfab9c9 |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-12-17T12:08:19Z |
| publishDate | 2014-09-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-df299179f7a749f9b2fcef757cfab9c92022-12-21T21:49:31ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742014-09-0129e21610.1097/GOX.000000000000017501720096-201409000-00007Great Toe Necrosis Predicts an Unfavorable Limb Salvage PrognosisHitomi Sano, MD, PhD0Shigeru Ichioka, MD, PhD1From the Department of Surgical Science, Graduate School of Medicine, University of Tokyo, Tokyo, Japan;Department of Plastic and Reconstructive Surgery, Saitama Medical University Hospital, Saitama, Japan.Summary: The initial location of necrosis may affect the limb salvage rate. This study of 130 patients with chronic toe ulcers or gangrene was performed to assess whether the location of initial necrosis in the toes affected limb salvage prognosis. The patients were divided into 2 groups according to whether the initial necrosis was in the great toe or in other toes. Limb salvage prognosis was determined retrospectively. In the great toe group, the rates of total toe loss and major amputation were 50.0% and 24.4%, respectively. When the initial necrosis was in other toes, these rates were 27.3% and 9.3%, respectively. Great toe necrosis is associated with significantly higher rates of total toe loss (odds ratio = 3.10; P = 0.003; 95% confidence interval, 1.43−6.68) and major amputation (odds ratio = 3.66; P = 0.007; 95% confidence interval, 1.37−9.79). The great toe is supplied by 3 source arteries, whereas the lesser toes are fed by 1 or 2 arteries. Therefore, necrosis initiating from the great toe may reflect the presence of severe vascular disorders. The great toe is also anatomically connected to much of the foot via the tendons. Infection is more likely to spread along these tendons, which may reduce limb prognosis. Thus, the initial location of necrosis may be predictive of limb prognosis.http://journals.lww.com/prsgo/Fulltext/2014/09000/Article.7.aspx |
| spellingShingle | Hitomi Sano, MD, PhD Shigeru Ichioka, MD, PhD Great Toe Necrosis Predicts an Unfavorable Limb Salvage Prognosis Plastic and Reconstructive Surgery, Global Open |
| title | Great Toe Necrosis Predicts an Unfavorable Limb Salvage Prognosis |
| title_full | Great Toe Necrosis Predicts an Unfavorable Limb Salvage Prognosis |
| title_fullStr | Great Toe Necrosis Predicts an Unfavorable Limb Salvage Prognosis |
| title_full_unstemmed | Great Toe Necrosis Predicts an Unfavorable Limb Salvage Prognosis |
| title_short | Great Toe Necrosis Predicts an Unfavorable Limb Salvage Prognosis |
| title_sort | great toe necrosis predicts an unfavorable limb salvage prognosis |
| url | http://journals.lww.com/prsgo/Fulltext/2014/09000/Article.7.aspx |
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