Diabetic Foot Clinical Trial
— MetaMetOfficial title:
Randomised Controlled Trial Comparing Metatarsal Method of Transection Using Bone Cutters or Bone Saw on Outcomes After Ray Amputation (MetaMet)
NCT number | NCT05804565 |
Other study ID # | 122/12 |
Secondary ID | |
Status | Recruiting |
Phase | N/A |
First received | |
Last updated | |
Start date | January 1, 2023 |
Est. completion date | June 30, 2024 |
Toe amputation is a commonly performed operation for infection and/or ischaemia (tissue death due to lack of blood flow). However, a large number of patients having this surgery ultimately require further amputation due to poor wound healing, new infections and/or new ulcers. Research to date has focused on patient-related factors associated with poor wound healing (e.g. diabetes, lack of blood flow, poor kidney function). However, there is no research looking at the technical surgical aspects of the procedure, specifically how the toe bone is cut. For this feasibility study, we will recruit forty patients whom a consultant vascular surgeon has decided requires amputation of one-to-two adjacent toes. The participants will be randomised by a computer model into one of the two metatarsal transection methods (bone cutters or bone saw) and the rest of the procedure will be carried out in the standard fashion. Patients and assessors will be blinded to which transection method is chosen. Patients will undergo a post-operative foot x-ray to assess for bone fragments within 48 hours of surgery and another at six months to assess for bone healing. Patients will be asked to rate their pain in the post-operative period using the verbal rating score. Patients will be followed after discharge from hospital by their public health nurse, as is standard practice, with regular follow-up in the surgical outpatients to assess wound progress. Patients will be asked to rate their quality of life at six weeks and six months post-operatively. These assessments will be coordinated with their routine post-operative follow-up clinic appointments, so as not to inconvenience patients with supernumerary visits.
Status | Recruiting |
Enrollment | 40 |
Est. completion date | June 30, 2024 |
Est. primary completion date | December 31, 2023 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Consenting patients, aged 18 and over, undergoing transmetatarsal amputation of one-to-two adjacent toes Exclusion Criteria: - Significant peripheral arterial disease, as defined by ABPI <0.4 or digital pressures of <50mmHg, not undergoing concurrent revascularisation; - Patients undergoing amputation of three of more adjacent toes - Patients unfit for surgery; - Patients unable to provide informed consent |
Country | Name | City | State |
---|---|---|---|
Ireland | University College Hospital Galway | Galway |
Lead Sponsor | Collaborator |
---|---|
University College Hospital Galway |
Ireland,
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Geiss LS, Li Y, Hora I, Albright A, Rolka D, Gregg EW. Resurgence of Diabetes-Related Nontraumatic Lower-Extremity Amputation in the Young and Middle-Aged Adult U.S. Population. Diabetes Care. 2019 Jan;42(1):50-54. doi: 10.2337/dc18-1380. Epub 2018 Nov 8. — View Citation
Liu R, Petersen BJ, Rothenberg GM, Armstrong DG. Lower extremity reamputation in people with diabetes: a systematic review and meta-analysis. BMJ Open Diabetes Res Care. 2021 Jun;9(1):e002325. doi: 10.1136/bmjdrc-2021-002325. — View Citation
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Norvell DC, Czerniecki JM. Risks and Risk Factors for Ipsilateral Re-Amputation in the First Year Following First Major Unilateral Dysvascular Amputation. Eur J Vasc Endovasc Surg. 2020 Oct;60(4):614-621. doi: 10.1016/j.ejvs.2020.06.026. Epub 2020 Aug 13. — View Citation
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Skrepnek GH, Mills JL Sr, Lavery LA, Armstrong DG. Health Care Service and Outcomes Among an Estimated 6.7 Million Ambulatory Care Diabetic Foot Cases in the U.S. Diabetes Care. 2017 Jul;40(7):936-942. doi: 10.2337/dc16-2189. Epub 2017 May 11. — View Citation
* Note: There are 12 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Power Calculation for Definitive RTC | collect sufficient data to enable an accurate power calculation for a future randomised controlled trial | Six months | |
Secondary | Rate of Surgical Re-Intervention | To determine the effect of microsaw compared to bone cutters for toe amputation on rates of surgical reintervention at the index procedure site | Six months | |
Secondary | Rate of Hospital Re-Admissions | To determine the effect of microsaw compared to bone cutters for toe amputation on rates of hospital re-admissions directly related to the index surgical procedure | Six months | |
Secondary | Time to Wound Healing | To determine the effect of microsaw compared to bone cutters for toe amputation on time to healing of the index surgical wound | Six months | |
Secondary | Rate of Index Ulcer Healing | To determine the effect of microsaw compared to bone cutters for toe amputation on healing of the index ulcer | Six months | |
Secondary | Rate of Re-Infection | To determine the effect of microsaw compared to bone cutters for toe amputation on rates of re-infection at the index procedure site | six months | |
Secondary | Rate of Ulcer Recurrence | To determine the effect of microsaw compared to bone cutters for toe amputation on ulcer recurrence or further ulceration | Six months | |
Secondary | Rate of Recurrent Osteomyelitis | To determine the effect of microsaw compared to bone cutters for toe amputation on osteomyelitis recurrence adjacent to the index surgical site | Six months | |
Secondary | Rate of Resection Margin Positive Culture | To determine the effect of microsaw compared to bone cutters for toe amputation on resection margin culture positivity | Six months | |
Secondary | Patient-Reported Post-Operation Pain | To determine the effect of microsaw compared to bone cutters for toe amputation on patient-reported post-operative pain, as measured by the Verbal Rating Scale (VRS) | Six Months | |
Secondary | Patient-Reported Quality of Life | To determine the effect of microsaw compared to bone cutters for toe amputation on patient-reported health-related quality of life at six weeks and six months, as measured by the EQ-5D-5L tool | Six Months |
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