The Use of Flap Techniques to Preserve Limb Length in Patients with Transmetatarsal Amputations. 

 -  2024 
<br/><br/> 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. 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>0032-1052 
<br/><br/><label>Standard No.: </label>00006534-990000000-01974 [pii] 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Foot<br/>*Free Tissue Flaps<br/>Amputation, Surgical<br/>Foot/su [Surgery]<br/>Free Tissue Flaps/bs [Blood Supply]<br/>Humans<br/>Limb Salvage/mt [Methods]<br/>Lower Extremity/su [Surgery]<br/>Retrospective Studies<br/>Treatment Outcome--Automated
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Washington Hospital Center
<br/><br/><label>Index Terms--Occupation: </label><br/>MedStar General Surgery Residency<br/>MedStar Georgetown University Hospital/MedStar Washington Hospital Center<br/>Surgery/Plastic Surgery<br/>Surgery/Podiatric Surgery
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article