Canales Michael B, Heurich Maureen E, Mandela Ashley M, Razzante Mark C
Chief, Division of Podiatry, Podiatric Surgical Residency, St. Vincent Charity Medical Center, Cleveland, OH.
Resident, Postgraduate Year 2, Podiatric Surgical Residency, St. Vincent Charity Medical Center, Cleveland, OH.
J Foot Ankle Surg. 2017 May-Jun;56(3):609-612. doi: 10.1053/j.jfas.2017.01.016. Epub 2017 Mar 1.
Transmetatarsal amputation remains the standard treatment for the unsalvageable diabetic forefoot; however, this operation is often complicated by wound dehiscence, ulceration, and the need for additional surgery and tendon balancing. The technique described in the present report provides an uncomplicated suturing method for closure of a standard transmetatarsal amputation. A drill hole is created through the first, second, and fourth metatarsals, which facilitates added stability to the plantar flap of the residual metatarsals. The patients are encouraged to begin protected weightbearing as early as the first postoperative day. The security of the flap promotes immediate weightbearing, which could result in fewer postoperative complications of transmetatarsal amputations. Early weightbearing will not only encourage tendon rebalancing, but also could improve angiogenesis through capillary ingrowth.
经跖骨截肢术仍然是无法挽救的糖尿病前足的标准治疗方法；然而，该手术常因伤口裂开、溃疡以及需要额外手术和肌腱平衡而变得复杂。本报告中描述的技术提供了一种用于闭合标准经跖骨截肢术的简单缝合方法。通过第一、第二和第四跖骨钻一个孔，这有助于增加残余跖骨足底皮瓣的稳定性。鼓励患者在术后第一天尽早开始保护性负重。皮瓣的安全性促进了立即负重，这可能会减少经跖骨截肢术后的并发症。早期负重不仅会促进肌腱重新平衡，还可能通过毛细血管长入改善血管生成。
