Transmetatarsal amputation for advanced forefoot tissue loss in elderly patients

Transmetatarsal amputation is considered a useful procedure because it is more likely to preserve mobility than a major amputation. In this retrospective review of 33 consecutive transmetatarsal amputations for advanced tissue loss of the forefoot, a high revision rate to major amputation (18/33) was offset by a significantly greater chance of preserving independent mobility in patients whose heel was preserved (P = 0.01). There was no difference in the non-invasive test results, smoking or diabetes history, or in the age of those who healed or those who did not. Factors that may contribute to improved wound healing rates in the future include refinements in the use of non-invasive tests, improved wound care, and advances in techniques of revascularization.