Bik Patrick M, Heineman Kate, Levi Jennifer, Sansosti Laura E, Meyr Andrew J
Resident, Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, PA.
Clinical Assistant Professor, Departments of Surgery and Biomechanics, Temple University School of Podiatric Medicine, Philadelphia, PA.
J Foot Ankle Surg. 2022 Nov-Dec;61(6):1187-1190. doi: 10.1053/j.jfas.2021.10.035. Epub 2021 Nov 10.
Although generally considered to be both a durable and functional procedure for limb preservation, the transmetatarsal amputation (TMA) has high rates of complication, failure, revisional operation, and progression to more proximal amputation. The objective of this investigation was to determine the effect of remnant metatarsal parabola structure on healing outcomes following TMA. A retrospective chart review was performed of subjects undergoing a complete TMA with primary closure. We considered 4 patterns of remnant metatarsal parabola structure. TMA pattern type 1 was a normal parabola with the remnant second metatarsal extending furthest distally and slightly longer than the remnant first and third metatarsals with a gradual lateral taper. TMA pattern type 2 was the first metatarsal remnant extending furthest distally with a gradual lateral taper. TMA pattern type 3 was a relatively long fifth metatarsal remnant without the presence of a gradual lateral taper. And TMA pattern type 4 was a relatively short first metatarsal remnant with a relatively long second metatarsal with a gradual lateral taper. Seventy-three transmetatarsal amputations in 73 subjects met selection criteria. Thirty-nine (53.4%) amputations healed primarily at 90 days. No statistically significant differences were observed between groups with respect to the 90-day primary healing rate (p = .571) or 1-year ambulation rate without wound recurrence or reoperation (p = .811). These results might indicate that the remnant metatarsal structure does not have an effect on transmetatarsal amputation outcome. It is our hope that these results add to the body of knowledge and lead to further investigations into outcomes of limb preservation surgical interventions.
尽管跖骨截肢术（TMA）通常被认为是一种用于肢体保全的持久且有效的手术，但它的并发症、失败、翻修手术以及进展为更近端截肢的发生率都很高。本研究的目的是确定残余跖骨抛物线结构对TMA术后愈合结果的影响。对接受一期缝合的完全TMA患者进行了回顾性病历审查。我们考虑了4种残余跖骨抛物线结构模式。TMA模式1型是正常抛物线，残余第二跖骨向远端延伸最远，比残余第一和第三跖骨略长，呈逐渐向外侧变细。TMA模式2型是第一跖骨残余向远端延伸最远，呈逐渐向外侧变细。TMA模式3型是相对较长的第五跖骨残余，没有逐渐向外侧变细。TMA模式4型是相对较短的第一跖骨残余和相对较长的第二跖骨，呈逐渐向外侧变细。73名患者的73例跖骨截肢术符合入选标准。39例（53.4%）截肢在90天时一期愈合。各组之间在90天一期愈合率（p = 0.571）或无伤口复发或再次手术的1年行走率（p = 0.811）方面未观察到统计学显著差异。这些结果可能表明残余跖骨结构对跖骨截肢术的结果没有影响。我们希望这些结果能丰富知识体系，并引发对肢体保全手术干预结果的进一步研究。
