The Use of Flap Techniques to Preserve Limb Length in Patients with Transmetatarsal Amputations.
The Use of Flap Techniques to Preserve Limb Length in Patients with Transmetatarsal Amputations.
- 2024
BACKGROUND: Chronic lower extremity wounds affect up to 13% of the US population. Transmetatarsal amputation (TMA) is frequently performed in patients with chronic forefoot wounds. TMA allows limb salvage and preserves functional gait, without need for prosthesis. Traditionally, when tension-free primary closure is not possible, a higher-level amputation is performed. This is the first series to evaluate the outcomes of local and free flap coverage of TMA stumps in patients with chronic foot wounds. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. Copyright © 2023 by the American Society of Plastic Surgeons. CONCLUSIONS: Local and free flap reconstruction after TMA are viable methods of soft-tissue coverage for limb salvage. Applying plastic surgery flap techniques for TMA stump coverage allows for preservation of increased foot length and ambulation without a prosthesis. METHODS: A retrospective cohort of patients who underwent TMA with flap coverage from 2015 through 2021 was reviewed. Primary outcomes included flap success, early postoperative complications, and long-term outcomes (limb salvage and ambulatory status). Patient-reported outcome measures using the Lower Extremity Functional Scale (LEFS) were also collected. RESULTS: Fifty patients underwent 51 flap reconstructions (26 local, 25 free flap) after TMA. Average age and body mass index were 58.5 years and 29.8 kg/m 2 , respectively. Comorbidities included diabetes [ n = 43 (86%)] and peripheral vascular disease [ n = 37 (74%)]. Flap success rate was 100%. At a mean follow-up of 24.8 months (range, 0.7 to 95.7 months), the limb salvage rate was 86.3% ( n = 44). Forty-four patients (88%) were ambulatory. The LEFS survey was completed by 24 surviving patients (54.5%). Mean LEFS score was 46.6 +/- 13.9, correlating with 58.2% +/- 17.4% of maximal function.
English
0032-1052
00006534-990000000-01974 [pii]
*Foot
*Free Tissue Flaps
Amputation, Surgical
Foot/su [Surgery]
Free Tissue Flaps/bs [Blood Supply]
Humans
Limb Salvage/mt [Methods]
Lower Extremity/su [Surgery]
Retrospective Studies
Treatment Outcome--Automated
MedStar Washington Hospital Center
MedStar General Surgery Residency
MedStar Georgetown University Hospital/MedStar Washington Hospital Center
Surgery/Plastic Surgery
Surgery/Podiatric Surgery
Journal Article
BACKGROUND: Chronic lower extremity wounds affect up to 13% of the US population. Transmetatarsal amputation (TMA) is frequently performed in patients with chronic forefoot wounds. TMA allows limb salvage and preserves functional gait, without need for prosthesis. Traditionally, when tension-free primary closure is not possible, a higher-level amputation is performed. This is the first series to evaluate the outcomes of local and free flap coverage of TMA stumps in patients with chronic foot wounds. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. Copyright © 2023 by the American Society of Plastic Surgeons. CONCLUSIONS: Local and free flap reconstruction after TMA are viable methods of soft-tissue coverage for limb salvage. Applying plastic surgery flap techniques for TMA stump coverage allows for preservation of increased foot length and ambulation without a prosthesis. METHODS: A retrospective cohort of patients who underwent TMA with flap coverage from 2015 through 2021 was reviewed. Primary outcomes included flap success, early postoperative complications, and long-term outcomes (limb salvage and ambulatory status). Patient-reported outcome measures using the Lower Extremity Functional Scale (LEFS) were also collected. RESULTS: Fifty patients underwent 51 flap reconstructions (26 local, 25 free flap) after TMA. Average age and body mass index were 58.5 years and 29.8 kg/m 2 , respectively. Comorbidities included diabetes [ n = 43 (86%)] and peripheral vascular disease [ n = 37 (74%)]. Flap success rate was 100%. At a mean follow-up of 24.8 months (range, 0.7 to 95.7 months), the limb salvage rate was 86.3% ( n = 44). Forty-four patients (88%) were ambulatory. The LEFS survey was completed by 24 surviving patients (54.5%). Mean LEFS score was 46.6 +/- 13.9, correlating with 58.2% +/- 17.4% of maximal function.
English
0032-1052
00006534-990000000-01974 [pii]
*Foot
*Free Tissue Flaps
Amputation, Surgical
Foot/su [Surgery]
Free Tissue Flaps/bs [Blood Supply]
Humans
Limb Salvage/mt [Methods]
Lower Extremity/su [Surgery]
Retrospective Studies
Treatment Outcome--Automated
MedStar Washington Hospital Center
MedStar General Surgery Residency
MedStar Georgetown University Hospital/MedStar Washington Hospital Center
Surgery/Plastic Surgery
Surgery/Podiatric Surgery
Journal Article