Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea.
Department of Surgery, Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom.
J Reconstr Microsurg. 2021 Nov;37(9):728-734. doi: 10.1055/s-0041-1726394. Epub 2021 Mar 31.
Transmetatarsal amputation (TMA) preserves functional gait while avoiding the need for prosthesis. However, when primary closure is not possible after amputation, higher level amputation is recommended. We hypothesize that reconstruction of the amputation stump using free tissue transfer when closure is not possible can achieve similar benefits as primarily closed TMAs.
Twenty-eight TMAs with free flap reconstruction were retrospectively reviewed in 27 diabetic patients with a median age of 61.5 years from 2004 to 2018. The primary outcome was limb salvage rate, with additional evaluation of flap survival, ambulatory status, time until ambulation, and further amputation rate. In addition, subgroup analysis was performed based on the microanastomosis type.
Flap survival was 93% (26 of 28 flaps) and limb salvage rate of 93% (25 of 27 limbs) was achieved. One patient underwent a second free flap reconstruction. In the two failed cases, higher level amputation was required. Thirteen flaps had partial loss or other complications which were salvaged with secondary intension or skin grafts. Median time until ambulation was 14 days following reconstruction (range: 9-20 days). Patients were followed-up for a median of 344 days (range: 142-594 days). Also, 88% of patients reported good ambulatory function, with a median ambulation score of 4 out of 5 at follow-up. There was no significant difference between the subgroups based on the microanastomosis type.
TMA with free flap reconstruction is an effective method for diabetic limb salvage, yielding good functional outcomes and healing results.
跖骨间截肢（TMA）在保留功能性步态的同时避免了对假体的需求。然而，截肢后如果无法直接闭合伤口，建议进行更高水平的截肢。我们假设，当无法闭合伤口时，使用游离组织转移重建截肢残端可以获得与直接闭合 TMA 相似的益处。
回顾性分析了 2004 年至 2018 年间 27 例糖尿病患者的 28 例 TMA 游离皮瓣重建病例，患者年龄中位数为 61.5 岁。主要观察指标为保肢率，同时评估皮瓣存活率、步行状态、开始行走的时间和进一步截肢率。此外，还根据微血管吻合类型进行了亚组分析。
皮瓣存活率为 93%（26/28 个皮瓣），保肢率为 93%（25/27 条肢体）。1 例患者接受了第二次游离皮瓣重建。在 2 例失败病例中，需要进行更高水平的截肢。13 个皮瓣出现部分坏死或其他并发症，通过二次缝合或植皮得以挽救。重建后平均 14 天（范围：9-20 天）开始行走。患者平均随访 344 天（范围：142-594 天）。此外，88%的患者报告步行功能良好，随访时平均步行评分为 5 分中的 4 分。基于微血管吻合类型的亚组之间无显著差异。
糖尿病患者的 TMA 游离皮瓣重建是一种有效的保肢方法，可获得良好的功能结果和愈合效果。
