000			03729nam a22005537a 4500
008			240723s20242024 xxu||||| |||| 00| 0 eng d
022			_a0032-1052
024			_a00006534-990000000-01974 [pii]
040			_aOvid MEDLINE(R)
099			_a37289940
245			_aThe Use of Flap Techniques to Preserve Limb Length in Patients with Transmetatarsal Amputations.
251			_aPlastic & Reconstructive Surgery. 153(4):944-954, 2024 Apr 01.
252			_aPlast Reconstr Surg. 153(4):944-954, 2024 Apr 01.
253			_aPlastic and reconstructive surgery
260			_c2024
260			_p2024 Apr 01
260			_fFY2024
265			_sppublish
265			_tMEDLINE
520			_aBACKGROUND: 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.
520			_aCLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. Copyright © 2023 by the American Society of Plastic Surgeons.
520			_aCONCLUSIONS: 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.
520			_aMETHODS: 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.
520			_aRESULTS: 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.
546			_aEnglish
650			_a*Foot
650			_a*Free Tissue Flaps
650			_aAmputation, Surgical
650			_aFoot/su [Surgery]
650			_aFree Tissue Flaps/bs [Blood Supply]
650			_aHumans
650			_aLimb Salvage/mt [Methods]
650			_aLower Extremity/su [Surgery]
650			_aRetrospective Studies
650			_aTreatment Outcome
650			_zAutomated
651			_aMedStar Washington Hospital Center
656			_aMedStar General Surgery Residency
656			_aMedStar Georgetown University Hospital/MedStar Washington Hospital Center
656			_aSurgery/Plastic Surgery
656			_aSurgery/Podiatric Surgery
657			_aJournal Article
700			_aDeldar, Romina _bMGUH _cMedStar General Surgery Residency _dMD
700			_aFan, Kenneth L _bMWHC
700			_aSteinberg, John _bMWHC
790			_aDeldar R, Sayyed AA, Cach G, Choi C, Garada F, Atves JN, Steinberg JS, Fan KL, Attinger CE, Evans KK
856			_uhttps://dx.doi.org/10.1097/PRS.0000000000010815 _zhttps://dx.doi.org/10.1097/PRS.0000000000010815
942			_cART _dArticle
999			_c14324 _d14324