Evidence map›Paper›PMID 30286045›Full record

ArticlePlastic and reconstructive surgery2019

Is Reconstruction Preserving the First Ray or First Two Rays Better Than Full Transmetatarsal Amputation in Diabetic Foot?

Young Chul Suh, Beatriz Hatsue Kushida-Contreras, HyunSuk Peter Suh, Ho Seung Lee, Woo Je Lee, Seung Hwan Lee, Joon Pio Jp Hong

Abstract read
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In one paragraph

Article in Plastic and reconstructive surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
2.0field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 23 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 1 institution in 2 countries.

Young Chul SuhFrom the Departments of Plastic and Reconstructive Surgery, Orthopedic Surgery, Endocrinology, and Cardiology, Asan Medical Center, University of Ulsan, College of Medicine.
Beatriz Hatsue Kushida-ContrerasFrom the Departments of Plastic and Reconstructive Surgery, Orthopedic Surgery, Endocrinology, and Cardiology, Asan Medical Center, University of Ulsan, College of Medicine.
HyunSuk Peter SuhFrom the Departments of Plastic and Reconstructive Surgery, Orthopedic Surgery, Endocrinology, and Cardiology, Asan Medical Center, University of Ulsan, College of Medicine.
Ho Seung LeeFrom the Departments of Plastic and Reconstructive Surgery, Orthopedic Surgery, Endocrinology, and Cardiology, Asan Medical Center, University of Ulsan, College of Medicine.
Woo Je LeeFrom the Departments of Plastic and Reconstructive Surgery, Orthopedic Surgery, Endocrinology, and Cardiology, Asan Medical Center, University of Ulsan, College of Medicine.
Seung Hwan LeeFrom the Departments of Plastic and Reconstructive Surgery, Orthopedic Surgery, Endocrinology, and Cardiology, Asan Medical Center, University of Ulsan, College of Medicine.
Joon Pio Jp HongFrom the Departments of Plastic and Reconstructive Surgery, Orthopedic Surgery, Endocrinology, and Cardiology, Asan Medical Center, University of Ulsan, College of Medicine.
University of Ulsan · KR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe benefits of total transmetatarsal amputation over higher level amputation are well known. However, there are no studies evaluating the effects of first ray- or first two ray-sparing transmetatarsal amputation with flap coverage. The authors evaluated this approach with regard to functional outcome and to identify long-term complications.

methodsRetrospective data of 59 patients were evaluated according to their surgical method. Complete transmetatarsal amputation with free flap reconstruction was designated as the transmetatarsal amputation group with 27 patients and first ray- or first two ray-preserving transmetatarsal amputation with free flap reconstruction was designated as the ray group, with 32 patients. Demographics, flap outcomes, additional procedures after initial healing, and functional outcomes were measured and evaluated.

resultsThere was no statistically significant difference in demographic distribution and flap outcomes in either group, except for poor blood glucose control in the ray group. Additional procedures after initial healing showed no statistical difference, but the tendency of minor procedures was higher in the ray group. The maximum achieved ambulatory function was significantly better in the ray group, with an ambulatory function score of 4.4 compared with 3.7 in the transmetatarsal amputation group (p = 0.012).

conclusionsThe preservation of the first ray or first two rays with free flap reconstruction may functionally benefit the patients despite the higher tendency toward minor procedures after initial healing. Furthermore, the progressive deformity of the preserved first and second toes will inevitably occur, requiring patients to undergo further surgery. Further studies are warranted to evaluate this approach. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Indexed as

AdultAgedAmputation, SurgicalCohort StudiesDiabetic FootFemaleFollow-Up StudiesFree Tissue FlapsGaitHumansKaplan-Meier EstimateMaleMetatarsal BonesMiddle AgedOrgan Sparing TreatmentsPlastic Surgery Procedures

Identifiers

PMID30286045
OpenAlexW2924336948

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.