Circulatory disorders in the foot or the toes can cause the tissue to die (necrosis). Sometimes, the only way to stop tissue with a poor blood supply from necrotising is to amputate toes or part of the foot.
Circulatory disorders resulting from vascular calcification (arteriosclerosis) can lead to tissue damage on the foot or the toes. This in turn causes ulcers and necrosis of the tissue if it reaches an advanced stage. Patients with diabetes mellitus are particularly at risk. Toe amputation is often the only way to save the foot or leg in the event of necrosis.
What preparations are carried out before the procedure?
The affected foot is thoroughly examined before the surgery. The circulation is checked with an ultrasound or with a contrast agent x-ray (angiography).
All blood-thinning medication must be discontinued prior to surgery. As is customary before operations, blood tests, an ECG and blood pressure measurements are also undertaken. Patients should have an empty stomach for the procedure.
How is the operation carried out?
Depending on the patient's condition and just how much of the toe or foot needs to be amputated, the procedure will be carried out under general or regional anaesthetic. The operation can be performed on an outpatient basis.
A sleeve is usually laid over the thigh to prevent more extensive haemorrhaging during the operation. Diseased, necrotic or infected tissue is then removed. Where possible, the amputation is restricted to the affected region of the body. However, healthy tissue sometimes also needs to be removed, i.e. if it is obvious that it also has a very poor blood flow. The extent of the operation often does not become apparent until during the surgery.
The amputation wound is usually not closed with a suture. Wounds with a poor blood supply often heal better if the wound remains open. Sometimes the wound is covered with a skin graft.
What is the success rate of this procedure?
The success rates of toe amputations depend on the underlying disease. This surgery generally prevents the necrosis from spreading any further. However, if the blood supply remains poor, necrosis may sometimes reoccur. In such cases, further parts of the foot or the leg must be amputated.
What are the possible complications and risks of this procedure?
As with all surgery, the surgery may occasionally cause nerve or blood vessel damage. Wound healing disorders or infections are more likely to result from poor blood flow in this case than during other operations.
What happens after the operation?
After the operation, the patient usually undergoes open wound treatment. It takes the wound longer than usual to heal due to the reduced blood flow. The wound must be kept scrupulously clean at all times and be looked after only by specialist personnel to prevent infections.
Depending on the extent of the amputation, the patient may require special orthopaedic shoes afterwards.