TY  - BOOK
AU  - Deldar, Romina
AU  - Fan, Kenneth L
AU  - Steinberg, John
TI  - The Use of Flap Techniques to Preserve Limb Length in Patients with Transmetatarsal Amputations
SN  - 0032-1052
PY  - 2024///
KW  - *Foot
KW  - *Free Tissue Flaps
KW  - Amputation, Surgical
KW  - Foot/su [Surgery]
KW  - Free Tissue Flaps/bs [Blood Supply]
KW  - Humans
KW  - Limb Salvage/mt [Methods]
KW  - Lower Extremity/su [Surgery]
KW  - Retrospective Studies
KW  - Treatment Outcome
KW  - Automated
KW  - MedStar Washington Hospital Center
KW  - MedStar General Surgery Residency
KW  - MedStar Georgetown University Hospital/MedStar Washington Hospital Center
KW  - Surgery/Plastic Surgery
KW  - Surgery/Podiatric Surgery
KW  - Journal Article
N2  - 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
UR  - https://dx.doi.org/10.1097/PRS.0000000000010815
ER  -