Hakan Arslan, Muzaffer Altındaş, Anıl Demiröz


Approximately 80 percent of diabetic foot wounds arise from the front foot. Most of these wounds are associated with bone and joint involvement. Toe amputations and ray amputations are the most frequently performed surgical interventions for the lesions limited to front foot. Many diabetic patients refuse surgery although they have advanced deformities that may cause dangerous injuries. Considering these patients, we defined a new alternative surgical procedure protecting the external appearance of the toe. This surgical procedure is not perceived by patients as a toe-consuming operation.
Materials and Method
Between 01-04-2004 and 08-11-2012, 76 toe lesions of 66 diabetic patients were treated with a new surgical approach. 50 patients were male and 16 were female. Mean age was 60.4, mean duration of diabetes was 16,6 years.
The mean follow up duration was 26.4 months (range 12.0 to 71.4). In 47 patients, the surgical closure healed by primary intention (81%). Dehiscence occurred in 11 patients (19%). Infection of the surgical wound developed in four patients (6,9%). Ulcer relapse occurred in three patients (5.1%). In six patients (10.3%), an ulcer developed in the contralateral foot. Long term follow up revealed that almost the same or approximately close toe length and width without any deformity were seen in 66 toes (in 58 patients).


Removal of the involved bone and other involved tissues while preserving the skin and other healthy tissues to reconstruct an acceptable new toe is possible in this new technique.

Tam Metin:

PDF (English)



Reiber GE, Lipsky BA, Gibbons GW. The burden of diabetic foot ulcers. Am J Surg 1998; 176:5S-10S.

Attinger C. Soft Tissue Reconstructive Options for the Ulcereted or Gangrenous Diabetic Foot. In The Diabetic Foot, pp 391-433, edited by A Veves, JMGiurini, FW Lo Gerfo, Humana Press Totawa, New Jersey, 2006.

Giurini JM. Surgical Treatment of the Ulcereted Foot. In The Diabetic Foot, pp 335-362, edited by A Veves, JMGiurini, FW Lo Gerfo, Humana Press Totawa, New Jersey, 2006.

Morales Lozano R, Gonzalez Fernandez ML, Martinez Hernandez D, et al. Validating the probe-tobonetest and other tests for diagnosing chronic osteomyelitis in the diabetic foot. Diabetes Care. 2010 Oct;33(10):2140-5. doi: 10.2337/dc09-2309. Epub 2010 Jul 9

International Working Group on the Diabetic Foot. International consensus on the diabetic foot. Maastricht: International Working Group on the Diabetic Foot, 1999.

Armstrong DG, Rosales MA, Gashi A. Efficacy of fifth metatarsal head resection for treatment of chronic diabetic foot ulceration. J Am Podiatr Med Assoc 2005; 95:353-356.

Altindas M, Kilic A, Cinar C, et al. The Epidemiology of Foot Wounds in Patients with Diabetes: Description of 600 Consecutive Patients in Turkey. J Foot Ankle Surg 2011;50:146-152

Steed DL. Role of growth Factors in the Treatment of the Diabetic Foot Ulseration. In The Diabetic Foot, pp 447-458, edited by A Veves, JMGiurini, FW Lo Gerfo, Humana Press Totawa, New Jersey, 2006

Koller A. Internal pedal amputations. ClinPodiatr Med Surg 2008; 25:641-653.

Hamilton GA, Ford LA, Perez H, et al. Salvage of the neuropathic foot by using bone resection and tendon balancing: a retrospective review of 10 patients. J Foot Ankle Surg 2005; 44:37-43.

Griffiths GD, Wieman TJ. Metatarsal head resection for diabetic foot ulcers. Arch Surg 1990; 125:832-835.

Johnson JE, Anderson SA. One stage resection and pin stabilization of first metatarsophalangealjoint for chronic plantar ulcer with osteomyelitis. Foot Ankle Int 2010; 31:973-979.

Wieman TJ, Mercke YK, Cerrito PB, et al. Resection of the metatarsal head for diabetic foot ulcers. Am J Surg 1998; 176:436-441.

Faglia E, Clerici G, Caminiti M, et al. Feasibility and effectiveness of internal pedal amputation of phalanx or metatarsal head in diabetic patients with forefoot osteomyelitis. J Foot Ankle Surg 2012; 51:593-598.

Simon SR, Tejwani SG, Wilson DL, et al. Arthrodesis as an early alternative to nonoperative management of charcotarthropathy of the diabetic foot. J Bone Joint Surg Am 2000; 82:939-950.

Online ISSN:1308-8475
Basılı ISSN:1300-6878 (önceki)

Türk Plastik Rekonstrüktif ve Estetik Cerrahi Dergisi (Turk J Plast Surg),
Türk Plastik Rekonstrüktif ve Estetik Cerrahi Derneği'nin, Estetik Plastik Cerrahi Derneği'nin, Türkiye Interplast Derneği'nin ve Çene Yüz Cerrahları Derneği'nin yayın organıdır.