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Transmetatarsal amputation: three-year experience at Groote Schuur Hospital
B P Mwipatayi1, N G Naidoo, P C Jeffery
1Department of Surgery, Vascular Unit, Groote Schuur Hospital/University of Cape Town, Cape Town, South Africa. bibombe@iinet.net.au
Insights
Transmetatarsal amputation (TMA) for peripheral vascular disease can achieve good mobility despite a reputation for poor outcomes. Diabetic and nondiabetic patients showed no statistical difference in TMA outcomes.
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.
Abstract:
Transmetatarsal amputation (TMA) for peripheral vascular disease has the reputation of being an operation with a poor outcome. This retrospective study reviewed a 3-year consecutive series of TMA in diabetic and nondiabetic patients. All amputations performed for peripheral vascular disease at Groote Schuur Hospital from January 1999 to December 2002 were reviewed. Data were obtained from hospital records and operating theatre books. The following groups were defined for the purpose of this retrospective study: group 1, TMAs performed in diabetic patients; group 2, TMAs done in nondiabetic patients. Altogether, 43 TMAs were performed: 27 in group 1 and 16 in group 2. Perioperative mortality rates were 7% and 4%, respectively. Overall, the healing rate was 67%: 62% (17/27) in group 1 and 75% (12/16) in group 2. The median times to healing were 8 months in group 1 and 7 months in group 2. Toe pressure and the presence of advanced tibioperoneal disease influenced the outcome of TMA in diabetic patients. Transmetatarsal amputation with a healed stump provided our patients with good mobility. Prediction of healing after operation is unreliable. There was no statistical difference in outcome in diabetic (group 1) versus nondiabetic (group 2) patients.