443-P: Outcomes of Bedside Diabetic Foot Amputation by a Diabetologist

Complying with simple operating rules, a diabetologist might perform Bedside Toe Amputation (BTA) for necrosis complicating diabetic foot ulcer (DFU) in case of inappropriate delay scheduled or disagreement with the amputation level proposed by the surgeon. We conducted a monocentric, retrospective, observational study in our diabetes department. Patients with DFU and isolated toe necrosis indicating a transphalangeal amputation (TPA), a metatarsophalangeal disarticulation (MPD) or a single transmetatarsal amputation (TMA) decided during a multidisciplinary DFU team were included. The primary endpoint was the need for reoperation or reamputation (partial/complete TMA, transtibial (TTA) or transfemoral (TFA)) performed by a surgeon. From May 2016 to September 2020, 147 out of 709 patients admitted for DFU required a surgical treatment (21%). After DFU team agreement and patient’s informed consent obtained, 101/147 patients needed TPA, MPD or TMA (69%) and 43/101 were performed at bedside by the diabetologist (43%). The characteristics of the population were: men=75%, age=65±14 years, type 2 diabetes=95%, duration of diabetes=19±11 years, preoperative arteriography=84%, preoperative revascularization=30%, mean number of permeable arteries at the time of the procedure=2±0.9, permeable dorsal arch=58%, permeable plantar arch=45%. Type of BTA: TPA=28%, MPD=65%, TMA=7%. Median follow-up=12 months. Secondary conventional surgery was needed for 13 patients (30%) (TMA/TTA/debridement respectively in 54, 30 and 16% cases). Poor vascular arterial bed was the significant determinant of failure (≤ 1 leg artery, p=0.006). Annual mortality rates in the groups with or without the need for a surgeon were respectively 15 and 10% (p=0.6). Performed by a diabetologist, BTA might be an option to treat limited toe necrosis complicating DFU in case of ≥ 2 leg arteries permeable at the time of the procedure. A head-to-head comparison with conventional surgery is now required. Disclosure F. Feron: None. J. Riveline: None. J. Gautier: None. J. Kevorkian: None.