Predictors for the healing of transmetatarsal amputations: retrospective study of 91 amputations

This retrospective study reviewed 80 consecutive patients (mean age 62 years; range 21-91 years) who underwent 91 transmetatarsal amputations (TMAs) between 1995 and 2003. The mean follow-up was 12 +/- 1.36 months. Sixty-two TMAs healed initially (group 1), whereas 29 TMAs did not heal by 3 months (group 2). At the final examination, in groups 1 and 2, 63 of 91 (69%) limbs were healed. Of the 28 limbs that did not heal, 25 of 28 (89%) required further proximal amputation. Initial healing correlated significantly with the ability to ambulate (p < .0001) and overall limb salvage (p < .0001). In group 1, 20 of 27 (74%) limbs that were revascularized healed (p = .0336). Nonhealing amputations were associated with end-stage renal disease (13 of 19; 68%) (p = .0209) and leukocytosis (13 of 19; 68%) (p = .0052).