Transmetatarsal amputation: three-year experience at Groote Schuur Hospital

Area of Science:

• Vascular Surgery
• Diabetic Foot Complications
• Amputation Outcomes

Background:

• Transmetatarsal amputation (TMA) for peripheral vascular disease (PVD) is often associated with unfavorable results.
• Diabetic patients frequently undergo TMA, but outcomes compared to nondiabetic patients are debated.
• Assessing factors influencing TMA success is crucial for patient management.

Purpose of the Study:

• To evaluate the outcomes of transmetatarsal amputations (TMAs) in patients with peripheral vascular disease.
• To compare TMA success rates and complications between diabetic and nondiabetic patients.
• To identify predictors of healing and functional recovery after TMA.

Main Methods:

• A retrospective review of 43 consecutive transmetatarsal amputations (TMAs) for peripheral vascular disease (PVD) between January 1999 and December 2002.
• Patients were categorized into two groups: diabetic (Group 1) and nondiabetic (Group 2).
• Data collected included perioperative mortality, stump healing rates, time to healing, and functional mobility.

Main Results:

• Overall stump healing occurred in 67% of cases (62% in diabetics, 75% in nondiabetics).
• Perioperative mortality was 7% for diabetic patients and 4% for nondiabetic patients.
• While toe pressure and tibioperoneal disease impacted diabetic outcomes, no statistical difference in overall outcome was found between diabetic and nondiabetic groups.

Conclusions:

• Transmetatarsal amputation (TMA) can provide good mobility with a healed stump, challenging its reputation for poor outcomes.
• Diabetic and nondiabetic patients demonstrate comparable outcomes following TMA for peripheral vascular disease.
• Predicting healing after TMA remains challenging, highlighting the need for careful patient selection and management.