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Revision After Total Transmetatarsal Amputation.

Peter Kaiser1, Thomas Vincent Häller1, Ilker Uçkay2

  • 1Resident, Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.

The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons
|November 5, 2019
PubMed
Summary
This summary is machine-generated.

Total transmetatarsal amputation (TMA) may require revision surgery in 40% of adult patients. Postoperative infections and delayed healing increase revision risk, while Staphylococcus aureus infection appears protective.

Keywords:
Staphylococcus aureusantibiotic therapyfailureforefoot amputationoutcome

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Area of Science:

  • Podiatric surgery
  • Infectious disease
  • Surgical outcomes

Background:

  • Total transmetatarsal amputation (TMA) is a limb salvage procedure for severe foot conditions.
  • Predictive factors for TMA outcomes and bacterial involvement require further investigation.

Purpose of the Study:

  • To identify preoperative criteria and bacterial factors associated with revision surgery after TMA.
  • To compare outcomes between patients who underwent revision surgery and those who did not.

Main Methods:

  • Retrospective review of 96 adult patients (105 TMA procedures).
  • Comparison of patient groups with and without revision surgery.
  • Analysis of preoperative factors, including infection history and comorbidities.

Main Results:

  • 40% of patients required revision surgery; 17% minor and 14% major proximal reamputation.
  • Previous Staphylococcus aureus infection was associated with a lower revision risk (p=0.03).
  • Persistent postoperative infections and delayed wound healing significantly increased revision risk (p < .01).

Conclusions:

  • TMA is a viable option to prevent major amputations but carries a substantial revision risk.
  • Persistent infection and delayed healing are key predictors of revision surgery.
  • No preoperative selection criteria, except S. aureus infection, reliably predicted revision risk in this cohort.