Transmetatarsal Amputation for Infection or Gangrene in Patients With Diabetes Mellitus

McKittrick, Leland S.; McKittrick, John B.; Risley, Thomas S.

doi:10.1097/00000658-194910000-00019

Cited by 138 publications

(49 citation statements)

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“…Transmetatarsal amputation was first described as a method of partial foot preservation by McKittrick et al 12 in 1949. The present findings support those of prior studies showing suboptimal rates of healing of TMAs.…”

Section: Commentmentioning

confidence: 99%

Predictors of Healing and Functional Outcome Following Transmetatarsal Amputations

Landry

Silverman

Liem³

et al. 2011

Arch Surg

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Intervention: Transmetatarsal amputations performed in all patients.Main Outcome Measures: Transmetatarsal amputation healing, ambulation, living status, and survival. Demographic characteristics, preoperative vascular status, and perioperative variables were analyzed as predictor variables. Univariate and multivariate analyses were performed to determine predictors of healing and survival.Results: Sixty-two TMAs were performed in 57 patients. Healing occurred in 33 TMAs (53%), with 22 TMAs (35%) in patients who proceeded to below-knee amputation and 7 TMAs (11%) in patients who died without healing. No demographic or perioperative variables significantly predicted healing. Independent ambulation was achieved in 24 patients with healed TMAs (73%) but in only 4 patients with nonhealed TMAs (14%) (P Ͻ.001). Mean survival was 16.5 months (range, 0-94 months), with no difference between patients with healed and those with nonhealed TMA. Significant predictors of mortality were dialysis-dependent renal failure (odds ratio, 4.85; 95% confidence interval, 1.01-23.30) (P = .047), nonindependent living (17.80; 3.03-104.80) (P =.001), and need for preoperative revascularization (4.80; 1.24-18.50) (P =.02).Conclusions: Transmetatarsal amputations have low healing rates, and patient demographic characteristics and preoperative assessment do not help predict healing. Transmetatarsal amputation healing, however, significantly predicts subsequent ambulatory status and should be pursued in patients with good rehabilitation potential.

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Section: Commentmentioning

confidence: 99%

Predictors of Healing and Functional Outcome Following Transmetatarsal Amputations

Landry

Silverman

Liem³

et al. 2011

Arch Surg

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“…4 For example, at Deaconess Hospital, the mortality for major amputations fell from 11.6% in the years 1923-1943 to 6.6% in 1944-1949. 11,12 Another important achievement of the 20th century was the ability of revascularization and limb salvage. Frank Wheelock was the first American surgeon responsible for the end-toside femoral popliteal bypass graft.…”

Section: Discussionmentioning

confidence: 99%

The Diabetic Foot: A Historical Overview and Gaps in Current Treatment

Naves

2016

Advances in Wound Care

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“…The first detailed clinical description of diabetes complications in a patient with an infection was published in 1924 (8) and was followed by several other reports showing that different types of infection could also affect the control of blood glucose levels and whole body metabolism (9,10,11,12). However, it was only in 1940 that a hypothesis was formulated placing the consumption of dietary fats in parallel with infections as causes for the defective action of insulin and glucose intolerance in diabetes (13,14).…”

Section: Historical Aspectsmentioning

confidence: 99%

MECHANISMS IN ENDOCRINOLOGY: Metabolic and inflammatory pathways on the pathogenesis of type 2 diabetes

Coope

Torsoni

Velloso

2016

European Journal of Endocrinology

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Obesity is the main risk factor for type 2 diabetes (T2D). Studies performed over the last 20 years have identified inflammation as the most important link between these two diseases. During the development of obesity, there is activation of subclinical inflammatory activity in tissues involved in metabolism and energy homeostasis. Intracellular serine/threonine kinases activated in response to inflammatory factors can catalyse the inhibitory phosphorylation of key proteins of the insulin-signalling pathway, leading to insulin resistance. Moreover, during the progression of obesity and insulin resistance, the pancreatic islets are also affected by inflammation, contributing to b-cell failure and leading to the onset of T2D. In this review, we will present the main mechanisms involved in the activation of obesity-associated metabolic inflammation and discuss potential therapeutic opportunities that can be developed to treat obesity-associated metabolic diseases.

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Transmetatarsal Amputation for Infection or Gangrene in Patients With Diabetes Mellitus

Cited by 138 publications

References 0 publications

Predictors of Healing and Functional Outcome Following Transmetatarsal Amputations

Predictors of Healing and Functional Outcome Following Transmetatarsal Amputations

The Diabetic Foot: A Historical Overview and Gaps in Current Treatment

MECHANISMS IN ENDOCRINOLOGY: Metabolic and inflammatory pathways on the pathogenesis of type 2 diabetes

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