{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:39:05Z","timestamp":1787755145203,"version":"build-2784847793"},"reference-count":69,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"\n \n \n \u00bb Diabetic foot ulcers cause higher rates of amputation and mortality; amputations yield even higher mortality rates than diabetic foot ulcers. Conservative excisional surgical procedures could be a suitable alternative to amputations, with comparable results with respect to wound-healing and infection control. Also, toe-sparing conservative surgical procedures offer good to excellent outcomes when compared with the nonoperative standard of care.<\/jats:p>\n <\/jats:list-item>\n \n \u00bb Fourteen types of conservative surgical procedures were identified including bone excision with ulcerectomy, interphalangeal or metatarsophalangeal joint resection arthroplasty, internal pedal amputation of the phalangeal or metatarsal bone, distal Syme amputation, metatarsal osteotomy, metatarsal head resection, Achilles lengthening, gastrocnemius recession, selective plantar fascia release, percutaneous toe flexor tenotomy, and skin grafting.<\/jats:p>\n <\/jats:list-item>\n \n \u00bb Depending on the location of the ulcer or osteomyelitis, a decision-making tree tool has been developed to assist surgeons for the indication of the different conservative operations.<\/jats:p>\n <\/jats:list-item>\n \n \u00bb A striking underuse of the available conservative operations was noted. When indicated, the outcomes of conservative surgery were rated good to excellent; these procedures could be suitable alternatives to amputation.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>","DOI":"10.2106\/jbjs.rvw.19.00162","type":"journal-article","created":{"date-parts":[[2020,6,8]],"date-time":"2020-06-08T19:11:30Z","timestamp":1591643490000},"page":"e0162-e0162","source":"Crossref","is-referenced-by-count":20,"title":["Conservative Surgical Options for the Treatment of Forefoot Diabetic Ulcers and Osteomyelitis"],"prefix":"10.2106","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0094-9892","authenticated-orcid":false,"given":"Kaissar","family":"Yammine","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon"},{"name":"Diabetic Foot Clinic (K.Y.) and Center for Evidence-Based Anatomy, Sports, & Orthopedics Research (K.Y. and C.A.), Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3238-1800","authenticated-orcid":false,"given":"Chahine","family":"Assi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon"},{"name":"Diabetic Foot Clinic (K.Y.) and Center for Evidence-Based Anatomy, Sports, & Orthopedics Research (K.Y. and C.A.), Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,6]]},"reference":[{"issue":"1","key":"r1-20230807","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1111\/nyas.13569","article-title":"Update on management of diabetic foot ulcers","volume":"1411","author":"Everett","year":"2018","journal-title":"Ann N Y Acad Sci"},{"issue":"8","key":"r2-20230807","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1111\/dme.13973","article-title":"The cost of diabetic foot ulcers and amputations to the National Health Service in England","volume":"36","author":"Kerr","year":"2019","journal-title":"Diabet Med"},{"issue":"24","key":"r3-20230807","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1056\/NEJMra1615439","article-title":"Diabetic foot ulcers and their recurrence","volume":"376","author":"Armstrong","year":"2017","journal-title":"N Engl J Med"},{"issue":"6","key":"r4-20230807","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1097\/00152192-200511000-00007","article-title":"Health-related quality of life in diabetic patients with foot ulcers: literature review","volume":"32","author":"Goodridge","year":"2005","journal-title":"J Wound Ostomy Continence Nurs"},{"issue":"10","key":"r5-20230807","doi-asserted-by":"crossref","first-page":"1852","DOI":"10.2337\/dc15-0536","article-title":"Diabetes, lower-extremity amputation, and death","volume":"38","author":"Hoffstad","year":"2015","journal-title":"Diabetes Care"},{"issue":"1","key":"r6-20230807","doi-asserted-by":"crossref","first-page":"97","DOI":"10.2174\/1573399812666160523143354","article-title":"Prevalence and prognostic value of depression and anxiety in patients with diabetic foot ulcers and possibilities of their treatment","volume":"13","author":"Udovichenko","year":"2017","journal-title":"Curr Diabetes Rev"},{"issue":"1","key":"r7-20230807","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.jdiacomp.2014.09.006","article-title":"Is depression a risk factor for diabetic foot ulcers? 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