Mortality and Morbidity After Transmetatarsal Amputation: Retrospective Review of 101 Cases

Pollard, Jason D.; Hamilton, Graham A.; Rush, Shannon M.; Ford, Lawrence A.

doi:10.1053/j.jfas.2005.12.011

Cited by 118 publications

(89 citation statements)

References 21 publications

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“…This finding is somewhat surprising, given that about half of persons with foot and ankle amputation experience problems with wound healing, ulceration, breakdown of the skin, and other postsurgical complications [32][33]. Persons with foot and ankle amputation are more likely to progress to amputation at a more proximal level than persons with TT and TF amputation.…”

Section: Discussionmentioning

confidence: 99%

Predicting prosthetic prescription after major lower-limb amputation

Resnik

Borgia

2015

J Rehabil Res Dev

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Abstract-We describe prosthetic limb prescription in the first year following lower-limb amputation and examine the relationship between amputation level, geographic region, and prosthetic prescription. We analyzed 2005 to 2010 Department of Veterans Affairs (VA) Inpatient and Medical Encounters SAS data sets, Vital Status death data, and National Prosthetic Patient Database data for 9,994 Veterans who underwent lowerlimb amputation at a VA hospital. Descriptive statistics and bivariates were examined. Cox proportional hazard models identified factors associated with prosthetic prescription. Analyses showed that amputation level was associated with prosthetic prescription. The hazard ratios (HRs) were 1.41 for ankle amputation and 0.46 for transfemoral amputation compared with transtibial amputation. HRs for geographic region were Northeast = 1.49, Upper Midwest = 1.26, and West = 1.39 compared with the South (p < 0.001). African American race, longer length of hospital stay, older age, congestive heart failure, paralysis, other neurological disease, renal failure, and admission from a nursing facility were negatively associated with prosthetic prescription. Being married was positively associated. After adjusting for patient characteristics, people with ankle amputation were most likely to be prescribed a prosthesis and people with transfemoral amputation were least likely. Geographic variation in prosthetic prescription exists in the VA and further research is needed to explain why.

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Section: Discussionmentioning

confidence: 99%

Predicting prosthetic prescription after major lower-limb amputation

Resnik

Borgia

2015

J Rehabil Res Dev

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“…[39][40][41] Similarly, the presence of renal disease confers a dismal prognosis in terms of all foot-related outcomes among patients with diabetes. [42][43][44][45][46][47] Griffiths et al (1990) found that reduced creatinine clearance increased the risk for foot ulceration. [42] A precipitous rise in the relative risk (RR) for ischemic foot ulceration (RR=21.580, 95% CI: 4.838-96.251, p < 0.001) conferred by diabetic nephropathy has more recently been confirmed.…”

Section: The Diabetic Foot In Esrdmentioning

confidence: 99%

“…[45] A significant (p = 0.04) association between ESRD and failure of transmetatarsal amputations to heal has been reported. [46] Interestingly, the increased risk for amputation conferred by renal failure is seen in all ethnic groups in the United States. [47] Although most pronounced in ESRD, the increased incidence of diabetic foot complications is observed in all stages of diabetic nephropathy.…”

Section: The Diabetic Foot In Esrdmentioning

confidence: 99%

The Diabetic Foot in End Stage Renal Disease

et al. 2007

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Diabetic foot lesions remain a major cause of morbidity in patients with renal failure, especially those on dialysis. Foot complications are encountered at a more than twofold frequency in diabetic patients with end-stage renal disease, and the rate of amputations is 6.5-10 times higher in comparison to the general diabetic population. The causal pathways of the diabetic foot in renal failure are multiple and inter-related. Three major pathologies-neuropathy, ischemia, and infection-are the main contributory factors. Increased awareness of this condition and careful clinical examination are indispensable to avoid serious complications. Appropriate management needs to address all contributory factors. Treatment options include revascularization, off-loading to relieve high-pressure areas, and aggressive control of infection. Equally important is the collaboration between health care providers in a multidisciplinary foot care setting. Moreover, patient education on the measures required to achieve both primary and secondary prevention is of great value. Certainly, technical innovations have made considerable progress possible, but there is a need for further improvement to reduce the number of amputations.

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“…Transmetatarsal amputation was associated with an 87% complication rate in a retrospective review of 101 cases (in 90 patients) by Pollard and colleagues. 433 Predictors of healing included a palpable pedal pulse and restriction of amputation to the transmetatarsal site, whereas end-stage renal disease was a predictor of failure to heal.…”

Section: Surgery To Alter Biomechanicsmentioning

confidence: 99%