Transmetatarsal amputation: assessment of current selection criteria

Anthony, Thomas; Roberts, James M.; Modrall, J. Gregory; Huerta, Sergio; Asolati, Michele; Neufeld, John; Parker, Betty June; Yang, Weibin; Sarosi, George A.

doi:10.1016/j.amjsurg.2006.08.011

Cited by 60 publications

(42 citation statements)

References 12 publications

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“…Rehabilitation to ambulation is less complex in patients having the procedure for diabetes or infection compared to those undergoing it for peripheral arterial disease. Patients with peripheral arterial disease are more likely to have delayed wound healing in a transmetatarsal amputation, and thus they have a lower likelihood of post-operative ambulation [23]. The contrary is therefore true as well that although the transmetatarsal amputation is not a disfiguring amputation and ambulation will not come at an increased cost of energy expenditure compared to controls, it is still not guaranteed [2,23].…”

Section: Mid-foot and Distalmentioning

confidence: 93%

“…Amputations and disarticulations distal to the hind foot have a high success rate for ambulation, for example the transmetatarsal amputee ambulates without prosthesis over 75% of the time [23]. Rehabilitation to ambulation is less complex in patients having the procedure for diabetes or infection compared to those undergoing it for peripheral arterial disease.…”

Section: Mid-foot and Distalmentioning

confidence: 99%

“…Patients with peripheral arterial disease are more likely to have delayed wound healing in a transmetatarsal amputation, and thus they have a lower likelihood of post-operative ambulation [23]. The contrary is therefore true as well that although the transmetatarsal amputation is not a disfiguring amputation and ambulation will not come at an increased cost of energy expenditure compared to controls, it is still not guaranteed [2,23]. The normal mechanics of gait by keeping the lever arm of the foot are relatively maintained by amputations of the foot distal to the hind foot allowing for lower energy expenditure ambulation without prosthesis [50].…”

Section: Mid-foot and Distalmentioning

confidence: 99%

“…Transmetatarsal amputation is a great amputation option for forefoot pathology as it maximizes length, is cosmetic as it allows for regular shoe wear without prosthesis, and promotes independent ambulation [22]. Literature indicates that candidate selection is paramount or else revision procedures resulting in more proximal amputation [23]. Partial amputations of the forefoot including ray resections and toe amputations are twice as common in the United States than transtibial or transfemoral amputations [24].…”

Section: Mid-foot and Distalmentioning

confidence: 99%

See 3 more Smart Citations

A Surgeon’s Perspective on Lower Extremity Amputation and Rehabilitation

Donegan¹

2017

ORP

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Section: Mid-foot and Distalmentioning

confidence: 93%

Section: Mid-foot and Distalmentioning

confidence: 99%

Section: Mid-foot and Distalmentioning

confidence: 99%

Section: Mid-foot and Distalmentioning

confidence: 99%

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A Surgeon’s Perspective on Lower Extremity Amputation and Rehabilitation

Donegan¹

2017

ORP

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“…Anthony et al [11] reported that 82% of patients who underwent this procedure required further surgery due to postoperative complications, with Pollard and colleagues [12] reporting the need for a more proximal amputation in 32% of cases and hospital mortality (within 30 days of TMA) of 1.98%. These results highlight the need to address factors likely to cause or contribute to subsequent tissue breakdown.…”

Section: Reducing Complicationsmentioning

confidence: 99%

Transmetatarsal Amputation: A Case Series and Review of the Literature

McCallum

Tagoe

2012

Journal of Aging Research

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Foot ulceration is a major cause of morbidity amongst patients with diabetes. In severe cases of ulceration, osteomyelitis and amputation can ensue. A distinct lack of agreement exists on the most appropriate level of amputation in cases of severe foot ulceration/infection to provide predictable healing rates. This paper provides an overview of the transmetatarsal amputation (TMA) as a limb salvage procedure and is written with the perspective and experiences of the Department of Podiatric Surgery at West Middlesex University Hospital (WMUH). We have reflected on the cases of 11 patients (12 feet) and have found the TMA to be an effective procedure in the management of cases of severe forefoot ulceration and infection.

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Predicting reamputation risk in patients undergoing lower extremity amputation due to the complications of peripheral artery disease and/or diabetes

Czerniecki

Thompson

Littman

et al. 2019

British Journal of Surgery

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Background Patients undergoing amputation of the lower extremity for the complications of peripheral artery disease and/or diabetes are at risk of treatment failure and the need for reamputation at a higher level. The aim of this study was to develop a patient‐specific reamputation risk prediction model. Methods Patients with incident unilateral transmetatarsal, transtibial or transfemoral amputation between 2004 and 2014 secondary to diabetes and/or peripheral artery disease, and who survived 12 months after amputation, were identified using Veterans Health Administration databases. Procedure codes and natural language processing were used to define subsequent ipsilateral reamputation at the same or higher level. Stepdown logistic regression was used to develop the prediction model. It was then evaluated for calibration and discrimination by evaluating the goodness of fit, area under the receiver operating characteristic curve (AUC) and discrimination slope. Results Some 5260 patients were identified, of whom 1283 (24·4 per cent) underwent ipsilateral reamputation in the 12 months after initial amputation. Crude reamputation risks were 40·3, 25·9 and 9·7 per cent in the transmetatarsal, transtibial and transfemoral groups respectively. The final prediction model included 11 predictors (amputation level, sex, smoking, alcohol, rest pain, use of outpatient anticoagulants, diabetes, chronic obstructive pulmonary disease, white blood cell count, kidney failure and previous revascularization), along with four interaction terms. Evaluation of the prediction characteristics indicated good model calibration with goodness‐of‐fit testing, good discrimination (AUC 0·72) and a discrimination slope of 11·2 per cent. Conclusion A prediction model was developed to calculate individual risk of primary healing failure and the need for reamputation surgery at each amputation level. This model may assist clinical decision‐making regarding amputation‐level selection.

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Transmetatarsal amputation: assessment of current selection criteria

Cited by 60 publications

References 12 publications

A Surgeon’s Perspective on Lower Extremity Amputation and Rehabilitation

A Surgeon’s Perspective on Lower Extremity Amputation and Rehabilitation

Transmetatarsal Amputation: A Case Series and Review of the Literature

Predicting reamputation risk in patients undergoing lower extremity amputation due to the complications of peripheral artery disease and/or diabetes

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