Open Foot/Toe Amputation and Hydrocolloid Dressing as Wound Management in Patients with Infected PAOD and Diabetic Foot - Long-term Follow-up

Background: Diabetic patients with peripheral arterial occlusion disease (PAOD) often suffer from other systemic diseases and are prone to severe wound infection. All patients prefer less and shorter surgical amputation and wish to preserve their toes and feet as long as possible. On the other hand, the traditional closed toe and foot amputations tend to shorten the toes and feet which may hardly be acceptable to diabetic patients with PAOD, both physical and psychological. Aim and Objectives: Our aim is to propose an option of wound management in patients with PAOD and diabetic foot to control infection, reduce the frequency of operation and anesthesia, and finally preserve the foot length and keep the ankle function. Materials and Methods: A total of 61 consecutive patients, aged 43-89 years, with infected PAOD and diabetic foot were studied; all patients underwent vascular bypass surgery and different levels of open foot/toe amputation depending on the severity of infection followed by modern dressings. Those who followed up for 3 years were reported. Results: Almost all patients who underwent open foot/toe amputation with hydrocolloid dressing experienced complete wound healing with or without skin grafting in 6 months. The time from definite amputation to ready to skin graft was approximately 3 weeks, and the mean time to complete wound healing without skin graft was 2 months. Conclusion: Open foot/toe amputation and hydrocolloid dressings was proved to be an effective alternative to control infection, improve wound healing, reduce the frequency of anesthesia and potential operation, and finally may preserve the foot length and keep the ankle function.