Related Experiment Videos
Open transmetatarsal amputation in the treatment of severe foot infections
J R Durham1, D M McCoy, A P Sawchuk
1Department of Surgery, University of Illinois College of Medicine, Chicago.
Abstract:
Severe forefoot infections may lead to limb loss, even if addressed aggressively. Infection or gangrene that compromises the plantar skin flap may preclude a standard transmetatarsal or midfoot amputation, thereby culminating in a below-knee amputation. We report a series of forefoot infections with loss of the distal plantar skin. Open or guillotine amputation at the mid-metatarsal level led to a high rate of healing and a durable stump, provided that the level of infection did not extend beyond the metatarsal heads. Wound closure was obtained by wound contracture alone or by use of partial-thickness skin grafting. Rehabilitation was dependable. The association of diabetes mellitus or gangrene did not adversely affect outcome. Open transmetatarsal amputation is a safe surgical option preferable to midfoot or below-knee amputation for the treatment of severe forefoot infection that does not extend proximally beyond the metatarsal heads.
Insights
Open transmetatarsal amputation is a safe surgical option for severe forefoot infections. This procedure offers a high healing rate and durable stump, avoiding more extensive limb amputations.
Area of Science:
- Podiatric surgery
- Infectious disease management
- Limb salvage procedures
Background:
- Severe forefoot infections pose a significant risk of limb loss.
- Compromised plantar skin flaps can necessitate below-knee amputation over transmetatarsal or midfoot amputation.
Purpose of the Study:
- To evaluate the efficacy of open transmetatarsal amputation for severe forefoot infections with distal plantar skin loss.
- To determine if this approach provides a durable stump and high healing rate.
Main Methods:
- A series of patients with forefoot infections and distal plantar skin loss were treated with open or guillotine amputation at the mid-metatarsal level.
- Wound closure was achieved via wound contracture or partial-thickness skin grafting.
Main Results:
- Open transmetatarsal amputation demonstrated a high rate of healing and produced a durable stump when infection did not extend beyond the metatarsal heads.
- Diabetes mellitus or gangrene did not negatively impact the outcomes.
- Rehabilitation was consistently dependable.
Conclusions:
- Open transmetatarsal amputation is a safe and preferable surgical option for severe forefoot infections not extending beyond the metatarsal heads.
- This technique can effectively salvage the limb, avoiding more proximal amputations like midfoot or below-knee procedures.