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Is Reconstruction Preserving the First Ray or First Two Rays Better Than Full Transmetatarsal Amputation in Diabetic
Young Chul Suh1, Beatriz Hatsue Kushida-Contreras1, HyunSuk Peter Suh1
1From the Departments of Plastic and Reconstructive Surgery, Orthopedic Surgery, Endocrinology, and Cardiology, Asan Medical Center, University of Ulsan, College of Medicine.
Plastic and Reconstructive Surgery
|October 5, 2018
Summary
Preserving the first one or two rays during transmetatarsal amputation offers better functional outcomes, despite a higher need for minor follow-up procedures. This approach may lead to progressive deformity, requiring further surgical intervention.
Area of Science:
- Podiatric surgery
- Reconstructive surgery
- Amputation surgery
Background:
- Transmetatarsal amputation (TMA) benefits are established, but outcomes of ray-sparing TMA with flap coverage are unstudied.
- Evaluating functional outcomes and long-term complications of first ray- or first two ray-sparing TMA.
Purpose of the Study:
- To compare functional outcomes and complications between complete TMA and ray-sparing TMA with free flap reconstruction.
- To determine if preserving foot rays impacts patient function and long-term results.
Main Methods:
- Retrospective analysis of 59 patients undergoing TMA with free flap reconstruction.
- Patients categorized into complete TMA (n=27) and ray-sparing TMA (n=32) groups.
- Evaluation of demographics, flap outcomes, secondary procedures, and functional scores.
Main Results:
- No significant demographic or flap outcome differences, except poorer glucose control in the ray group.
- Ray-sparing TMA showed significantly better maximum ambulatory function (4.4 vs. 3.7, p=0.012).
- A trend towards more minor procedures in the ray-sparing group post-healing.
Conclusions:
- First ray- or two ray-sparing TMA with flap coverage may offer functional advantages.
- Higher incidence of minor procedures and potential for progressive deformity in the ray-sparing group.
- Further research is needed to fully assess the long-term implications of ray-sparing TMA.
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