Reoperation and Reamputation After Transmetatarsal Amputation: A Systematic Review and Meta-Analysis

Abstract Transmetatarsal amputations have generally been accepted as a relatively more definitive amputation compared with other lesser ray resections. However, many investigators have reported a high occurrence of more proximal amputation after transmetatarsal amputation. A systematic review was pe...

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Bibliographic Details
Published in:The Journal of foot and ankle surgery 2016-09, Vol.55 (5), p.1007-1012
Main Authors: Thorud, Jakob C., DPM, MS, AACFAS, Jupiter, Daniel C., PhD, Lorenzana, Jonathan, DPM, Nguyen, Tea Tu, DPM, Shibuya, Naohiro, DPM, MS, FACFAS
Format: Article
Language:English
Subjects:
Aged
Amputation - adverse effects
Amputation - methods
diabetic foot
Diabetic Foot - surgery
Female
Humans
limb salvage
Male
Metatarsal Bones - surgery
Middle Aged
midfoot amputation
minor amputation
Orthopedics
peripheral vascular disease
Prognosis
Reoperation - methods
Reoperation - statistics & numerical data
Risk Assessment
Severity of Illness Index
Wound Healing - physiology
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Summary:Abstract Transmetatarsal amputations have generally been accepted as a relatively more definitive amputation compared with other lesser ray resections. However, many investigators have reported a high occurrence of more proximal amputation after transmetatarsal amputation. A systematic review was performed to evaluate the occurrence of reamputation and reoperation after transmetatarsal amputations. A search of the Medline, CINAHL, and Cochrane Central databases yielded 159 abstracts. After review, 24 reports were included in the study. A total of 391 (26.9%) reoperations were identified after 1453 transmetatarsal amputations. Any level reamputation occurred in 152 (29.7%) of 365 transmetatarsal amputations and major amputation occurred in 380 (33.2%) of 1146 transmetatarsal amputations. Using a random effects model, the reoperation rate was estimated at 24.43% (95% confidence interval 11.64% to 37.21%), the reamputation rate was estimated at 28.37% (95% confidence interval 19.56% to 37.19%), and the major amputation rate was estimated at 30.16% (95% confidence interval 23.86% to 36.47%). These findings raise questions about the conventional wisdom of performing primary transmetatarsal amputation in lieu of other minor amputations, such as partial first ray amputation, and suggest that the choice between transmetatarsal amputation and other minor amputations might be a decision that depends on very patient-specific factors.
ISSN:1067-2516
1542-2224
DOI:10.1053/j.jfas.2016.05.011