Outcomes of Wound Healing and Limb Loss After Transmetatarsal Amputation in the Presence of Peripheral Vascular Disease

Transmetatarsal amputation (TMA) is the procedure of choice in treating forefoot gangrene and infection. Foot and ankle and vascular surgeons work closely together in limb salvage, but little is known about the timing of vascular intervention to achieve a healed amputation site. This study retrospec...

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Bibliographic Details
Published in:The Journal of foot and ankle surgery 2019-01, Vol.58 (1), p.47-51
Main Authors: Shi, Eric, Jex, Marshall, Patel, Sumer, Garg, Joy
Format: Article
Language:English
Subjects:
Adult
Amputation
angioplasty
arterial
bypass
diabetes
endovascular
Female
Humans
Male
Metatarsal Bones - surgery
Middle Aged
Peripheral Arterial Disease - surgery
Retrospective Studies
salvage
surgery
Treatment Outcome
Wound Healing
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Summary:Transmetatarsal amputation (TMA) is the procedure of choice in treating forefoot gangrene and infection. Foot and ankle and vascular surgeons work closely together in limb salvage, but little is known about the timing of vascular intervention to achieve a healed amputation site. This study retrospectively looked at 153 patients with peripheral vascular disease who underwent TMA with a minimum of a 3-year follow-up. A total of 102 patients received vascular intervention: 79 endovascular and 23 open bypass. The primary focus of this study was to look at the timing of vascular intervention, incidence of wound healing, and incidence of limb loss. There was an overall 44% rate of limb loss. Patients who underwent open bypass did better than those who underwent endovascular intervention with a lower incidence of limb loss (87% compared with 51%), and quicker time to wound healing. The timing of vascular intervention, performed either before or after TMA, had no association with wound healing or limb loss. Similarly, the time interval between vascular intervention and TMA had no association with wound healing or limb loss. Comorbidities, including end-stage renal disease on hemodialysis, hyperlipidemia, and congestive heart failure, showed a significant association with TMA stump nonhealing and limb loss. Body mass index ≥30, end-stage renal disease on hemodialysis, and hyperlipidemia were all risk factors for limb loss.
ISSN:1067-2516
1542-2224
DOI:10.1053/j.jfas.2018.07.004