Complications Following Hallux Amputations With and Without Sesamoid Excision: A Retrospective Comparative Review

Background:Hallux amputations are commonly performed for conditions such as osteomyelitis, gangrene, and chronic ulceration.While wound complications and reoperation are well-recognized, the role of sesamoid excision in these complications remains unclear.This study evaluates complication rates associated with hallux amputations performed with and without sesamoid excision. Methods:This retrospective study included patients aged 18 years or older who underwent hallux amputation at the metatarsophalangeal joint level between 2012 and 2024.Complications were defined as the need for reoperation, postoperative incisional dehiscence, or wound complications leading to proximal amputation.Statistical analyses were performed using Fisher's exact test and logistic regression. Results:A total of 62 patients were included, with 27 undergoing sesamoid excision and 35 not undergoing sesamoid excision.The overall complication rate was significantly higher in the sesamoid excision group (40.74%) compared to the non-sesamoid excision group (17.14%) (p = 0.044).Patients who underwent sesamoid excision were 3.32 times more likely to experience complications (95% CI: 1.0344-10.6749).Peripheral arterial disease was a statistically significant risk factor for complications (p = 0.007), while hemoglobin A1c levels showed no significant correlation (p = 0.604).However, the study's statistical power of 42.79% presents a limitation, warranting cautious interpretation of the results. Conclusion:Sesamoid excision during hallux amputation was associated with a higher complication rate.The higher complication rate is potentially due to more extensive soft tissue dissection rather than the presence of an infectious nidus.As the first study to explore this relationship, these findings provide valuable insights and highlight the need for further prospective research to guide clinical decision-making.