Abstract
Transmetatarsal amputation (TMA) is the procedure of choice in treating forefoot gangrene
and infection. Foot and ankle and vascular surgeons work closely together in limb
salvage, but little is known about the timing of vascular intervention to achieve
a healed amputation site. This study retrospectively looked at 153 patients with peripheral
vascular disease who underwent TMA with a minimum of a 3-year follow-up. A total of
102 patients received vascular intervention: 79 endovascular and 23 open bypass. The
primary focus of this study was to look at the timing of vascular intervention, incidence
of wound healing, and incidence of limb loss. There was an overall 44% rate of limb
loss. Patients who underwent open bypass did better than those who underwent endovascular
intervention with a lower incidence of limb loss (87% compared with 51%), and quicker
time to wound healing. The timing of vascular intervention, performed either before
or after TMA, had no association with wound healing or limb loss. Similarly, the time
interval between vascular intervention and TMA had no association with wound healing
or limb loss. Comorbidities, including end-stage renal disease on hemodialysis, hyperlipidemia,
and congestive heart failure, showed a significant association with TMA stump nonhealing
and limb loss. Body mass index ≥30, end-stage renal disease on hemodialysis, and hyperlipidemia
were all risk factors for limb loss.
Keywords
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References
- Transmetatarsal amputations for infection or gangrene in patients with diabetes.Ann Surg. 1949; 130: 826-842
- Transmetatarsal amputation: a successful approach to limb salvage.J Am Podiatr Med Assoc. 1992; 82: 129-135
- Subtotal pedal amputations: biomechanical and intraoperative considerations.J Am Podiatr Med Assoc. 2001; 91: 6-12
- Transmetatarsal amputations.Orthop Clin North Am. 1973; 4: 31-42
- Transmetatarsal amputation: an 8-year experience.Ann R Coll Surg Engl. 2001; 83: 164-166
- Risk factors for early failure of surgical amputations: an analysis of 8,878 isolated lower extremity amputation procedures.J Am Coll Surg. 2013; 216: 836-844
- Predictors for the healing of transmetatarsal amputations: retrospective study of 91 amputations.Vascular. 2007; 15: 126-133
- Outcomes of transmetatarsal amputations in patients with diabetes mellitus.J Foot Ankle Surg. 1997; 36: 430-434
- Predictors of healing and functional outcome following transmetatarsal amputations.Arch Surg. 2011; 146: 1005-1009
- The role of revascularization in transmetatarsal amputations.J Am Podiatr Med Assoc. 2001; 91: 533-535
- Transmetatarsal amputation in patients with peripheral vascular disease.Eur J Vasc Surg. 1991; 5: 655-658
- Transmetatarsal amputation in the management of peripheral ischemia.Am J Surg. 1977; 134: 604-607
- Transmetatarsal amputation: the role of adjunctive revascularization.J Vasc Surg. 1991; 13: 705-711
- Trends in the care of the diabetic foot: expanded role of arterial reconstruction.Arch Surg. 1992; 127: 617-621
- Lower extremity minor amputations: the roles of diabetes mellitus and timing of revascularization.J Vasc Surg. 2005; 42: 476-480
- Risk factors for failure of transmetatarsal amputation in diabetic patients: a cohort study.Foot Ankle Int. 2009; 30: 1177-1182
- Reoperation and reamputation after transmetatarsal amputation: a systematic review and meta-analysis.J Foot Ankle Surg. 2016; 55: 1007-1012
- Survival following lower-limb amputation in a veteran population.J Rehabil Res Dev. 2001; 38: 341-345
- Society for Vascular Surgery limb stage and patient risk correlate with outcomes in an amputation prevention program.J Vasc Surg. 2016; 63: 1563-1573
- Outcomes of transmetatarsal amputations in patients with diabetes mellitus.J Foot Ankle Surg. 1997; 36: 430-434
- Outcomes after endovascular intervention for chronic critical limb ischemia.J Vasc Surg. 2011; 53: 1575-1581
- Patient recovery after infrainguinal bypass grafting for limb salvage.J Vasc Surg. 1998; 27: 25-63
- Influence of surgical or endovascular distal revascularization of the lower limbs on ischemic ulcer healing.J Cardiovasc Surg. 2011; 52: 381-389
Article info
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
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© 2018 by the American College of Foot and Ankle Surgeons. All rights reserved.
