Transmetatarsal amputation in patients with peripheral vascular disease

Area of Science:

• Vascular Surgery
• Podiatric Surgery
• Limb Salvage Procedures

Background:

• Transmetatarsal amputation (TMA) is associated with a historically poor healing rate, with recent reports indicating success below 50%.
• Peripheral vascular disease (PVD) and diabetes mellitus are common comorbidities in patients undergoing TMA, potentially impacting healing outcomes.

Purpose of the Study:

• To retrospectively evaluate the healing rate and outcomes of transmetatarsal amputations in patients with peripheral vascular disease.
• To identify factors influencing the success or failure of TMA in this patient population.

Main Methods:

• Retrospective review of 34 transmetatarsal amputations performed over a 5-year period.
• Analysis included patient demographics, comorbidities (diabetes, previous toe amputations), and surgical outcomes.
• Factors such as sympathectomy, arterial reconstruction, and peripheral pulses were examined for their influence on healing.

Main Results:

• An overall healing rate of 68% was observed across 34 transmetatarsal amputations.
• No significant difference in healing rates was found between diabetic (22 patients) and non-diabetic patients.
• Revision of failed TMAs resulted in a 78% healing rate (7 out of 9 patients), indicating salvageability at a higher amputation level.

Conclusions:

• Transmetatarsal amputation demonstrates a higher healing rate than previously reported, offering a viable limb salvage option for patients with PVD.
• The procedure provides a functional, prosthesis-free stump, particularly beneficial for patients with a limited life expectancy.
• Healing outcomes were not significantly influenced by diabetes, sympathectomy, prior arterial reconstruction, or palpable peripheral pulses.