Healing of Transmetatarsal Amputation in the Diabetic Patient: Is Angiography Predictive?
Section snippets
INTRODUCTION
Transmetatarsal amputation (TMA) is a durable reconstruction in the diabetic patient with forefoot tissue loss.1 However, failure to heal will still occur in a number of cases and may be related to wound factors, neuropathy, or insufficient vascular supply. A number of noninvasive vascular laboratory criteria have been correlated with the likelihood of healing of forefoot amputations.2, 3 However, no study has evaluated the relationship, if any, between foot arterial anatomy and the likelihood
METHODS
Diabetic patients undergoing TMA at our medical center over a 5-year period were identified from a query of our surgical registry. From this group, we identified a subset of patients who had also undergone lower extremity arteriography within 3 months of the TMA, either before or after. This subset of patients constitutes our study group.
The records, including hospitalization records, operative notes, clinic visits, and vascular laboratory studies, were reviewed. We recorded demographic
PATIENT POPULATION AND RESULTS
Forty-one patients were identified who underwent 44 TMAs (three had bilateral procedures). There were 29 men and 12 women, with a mean age of 59 ± 11 years. Thirty-two patients were Hispanic, seven were Caucasian, and five were African American.
Cardiovascular risk factors included hypertension in 76%, hyperlipidemia in 51%, cardiac disease in 51%, prior stroke in 7%, a history of prior smoking in 56%, and active smoking in 21%. Only four patients (10%) were on hemodialysis for chronic renal
DISCUSSION
Forefoot amputation in the form of TMA along with revascularization as needed allowed limb salvage in nearly two-thirds of diabetic patients. TMA thus appears to be a worthwhile intervention in diabetic patients. Revisions of the TMA were, however, frequently required and often still resulted in ultimate limb salvage.
Patients should not be denied the option of TMA on the basis of the arteriographic appearance of the foot since no correlation could be found between the angiographic foot anatomy
REFERENCES (7)
- et al.
Recommended standards for reports dealing with lower extremity ischemia: revised version
J Vasc Surg
(1997) - et al.
Angiographic scoring of vascular occlusive disease in the diabetic foot: relevance to bypass graft patency and limb salvage
J Vasc Surg
(2002) - et al.
A regional pedal ischemia scoring system for decision analysis in patients with heel ulceration
Am J Surg
(1998)
Cited by (41)
The Effect of Remnant Metatarsal Parabola Structure on Transmetatarsal Amputation Primary Healing and Durability
2022, Journal of Foot and Ankle SurgeryCitation Excerpt :We also never consider data to be definitive, but do think that these results might be worthy of attention and future investigation. First, these results appear to mirror the contemporary literature in terms of the primary healing rate of the TMA (1-21). We observed a primary healing rate of 53.4% at 90 postoperative days.
Risk factors for conversion of forefoot or midfoot amputations to below knee amputation
2022, Orthoplastic SurgeryAnalysis of Early Lower Extremity Re-amputation
2022, Annals of Vascular SurgeryPredictive Factors and Amputation Level for Reamputation in Patients With Diabetic Foot: A Retrospective Case-Control Study
2022, Journal of Foot and Ankle SurgeryTransmetatarsal Amputation Outcomes When Utilized to Address Foot Gangrene and Infection: A Retrospective Chart Review
2021, Journal of Foot and Ankle SurgeryCitation Excerpt :Existing studies comparing TMA healing rates and PAD have had mixed results. Some studies have demonstrated an increased failure rate of healing a TMA with a history of PAD (11,14), while others have not demonstrated such an association (17,18,24,26,27,32). In our study we did not find PAD to significantly affect the postoperative healing of a TMA.
Presented at the Fifteenth Annual Winter Meeting of the Peripheral Vascular Surgery Society, Steamboat Springs, CO, January 28–30, 2005.