Free Tissue Transfer versus Native Plantar Flap Reconstruction After Transmetatarsal Amputation: A Proof-of-Concept...

Area of Science:

• Orthopedics
• Biomedical Engineering
• Reconstructive Surgery

Background:

• Free tissue transfer (FTT) aids limb salvage in transmetatarsal amputation (TMA).
• FTT's bulk can impede footwear and ambulation, potentially increasing ulceration risk.
• Gait analysis is crucial for assessing functional outcomes post-TMA.

Purpose of the Study:

• To compare gait patterns in TMA patients reconstructed with FTT versus native plantar flaps.
• To assess the biomechanical impact of FTT closure on post-amputation ambulation.
• To evaluate FTT as a limb salvage option considering functional outcomes.

Main Methods:

• Nineteen TMA patients (native flap n=14, FTT n=5) underwent a 120-second gait test using wearable sensors.
• Gait parameters analyzed included cadence, speed, stride length, limb support, and postural sway (RMS).
• Univariate and multivariate analyses compared gait parameters between flap groups, controlling for confounders.

Main Results:

• No significant differences in gait speed, cadence, stride duration, or midswing elevation were found.
• Free tissue transfer (FTT) patients exhibited significantly higher root mean square (RMS) sway (P=0.041).
• Multivariate analysis indicated flap type was not independently associated with RMS sway; higher BMI and PVD were noted in the FTT group.

Conclusions:

• Spatiotemporal gait parameters were largely comparable between FTT and native flap reconstructions.
• While univariate analysis showed increased sway in FTT, this was not an independent factor after adjustment.
• FTT appears to be a valuable limb salvage option for TMA, with minimal impact on post-amputation ambulation.