Podiatric Medicine and Surgery Resident, Gundersen Health Systems, La Crosse, WI.
Podiatric Medicine and Surgery Resident, Gundersen Health Systems, La Crosse, WI.
J Foot Ankle Surg. 2022 May-Jun;61(3):537-541. doi: 10.1053/j.jfas.2021.10.005. Epub 2021 Oct 21.
In limb and life-threatening diabetic foot infections, transmetatarsal amputations are often indicated as a limb salvage procedure. The aim of this study is to analyze the long-term durability of initially successful transmetatarsal amputations in the diabetic population. We defined a successful transmetatarsal amputation as one which had clinical healing 1 year after surgery. A retrospective review of transmetatarsal amputations completed at our institution over an 11-year period was performed. We identified 83 amputations that met inclusion criteria. The mean follow-up was 4 years. The mean time to surgical healing was 109.8 days. After successfully healing the transmetatarsal amputation the long-term outcomes were analyzed. Re-ulcerations occurred in 44% of the transmetatarsal amputations a mean of 15 months after surgical healing. Patients who re-ulcerated were noted to be significantly younger (p value 0.02) with a significantly higher preprocedure hemoglobin A1c (p value < .001). Additional procedures after successful healing included 13 (15.66%) revision surgeries and 12 (14.46%) more proximal amputations. While transmetatarsal amputations remain a viable and durable limb preserving surgery, all patients who have undergone a transmetatarsal amputation should be monitored lifelong as they remain at risk for re-ulceration and more proximal amputation.
在危及肢体和生命的糖尿病足感染中，跖骨间截肢术通常作为一种保留肢体的手术方法。本研究旨在分析糖尿病患者中初次成功的跖骨间截肢术的长期耐久性。我们将成功的跖骨间截肢定义为术后 1 年临床愈合的截肢。对我院在 11 年期间完成的跖骨间截肢术进行了回顾性研究。我们确定了符合纳入标准的 83 例截肢。平均随访时间为 4 年。手术愈合的平均时间为 109.8 天。在跖骨间截肢成功愈合后，分析了长期结果。再溃疡发生在 44%的跖骨间截肢中，平均在手术愈合后 15 个月。再溃疡的患者明显更年轻（p 值 0.02），术前血红蛋白 A1c 明显更高（p 值 < 0.001）。成功愈合后的进一步手术包括 13 例（15.66%）修正手术和 12 例（14.46%）更靠近近端的截肢。虽然跖骨间截肢仍然是一种可行且持久的保留肢体的手术，但所有接受过跖骨间截肢的患者都应终身监测，因为他们仍然有再溃疡和更靠近近端截肢的风险。
