Deldar Romina, Cach Gina, Sayyed Adaah A, Truong Brian N, Kim Emily, Atves Jayson N, Steinberg John S, Evans Karen K, Attinger Christopher E
Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, D.C.
Georgetown University School of Medicine, Washington, D.C.
Plast Reconstr Surg Glob Open. 2022 May 25;10(5):e4350. doi: 10.1097/GOX.0000000000004350. eCollection 2022 May.
Transmetatarsal amputation (TMA) is performed in patients with nonhealing wounds of the forefoot. Compared with below-knee amputations, healing after TMA is less reliable, and often leads to subsequent higher-level amputation. The aim of this study was to evaluate the functional and patient-reported outcomes of TMA.
A retrospective review of patients who underwent TMA from 2013 to 2021 at our limb-salvage center was conducted. Primary outcomes included postoperative complications, secondary proximal lower extremity amputation, ambulatory status, and mortality. Univariate and multivariate analyses were performed to evaluate independent risk factors for higher-level amputation after TMA. Patient-reported outcome measures for functionality and pain were also obtained.
A total of 146 patients were identified. TMA success was achieved in 105 patients (72%), and 41 patients (28%) required higher-level amputation (Lisfranc: 31.7%, Chopart: 22.0%, below-knee amputations: 43.9%). There was a higher incidence of postoperative infection in patients who subsequently required proximal amputation (39.0 versus 9.5%, < 0.001). At mean follow-up duration of 23.2 months (range, 0.7-97.6 months), limb salvage was achieved in 128 patients (87.7%) and 83% of patients (n = 121) were ambulatory. Patient-reported outcomes for functionality corresponded to a mean maximal function of 58.9%. Pain survey revealed that TMA failure patients had a significantly higher pain rating compared with TMA success patients ( = 0.016).
TMA healing remains variable, and many patients will eventually require a secondary proximal amputation. Multi-institutional studies are warranted to identify perioperative risk factors for higher-level amputation and to further evaluate patient-reported outcomes.
经跖骨截肢术（TMA）适用于前足伤口不愈合的患者。与膝下截肢相比，TMA术后愈合的可靠性较低，且常导致后续更高平面的截肢。本研究的目的是评估TMA的功能及患者报告的结局。
对2013年至2021年在我们肢体挽救中心接受TMA的患者进行回顾性研究。主要结局包括术后并发症、继发近端下肢截肢、行走状态和死亡率。进行单因素和多因素分析以评估TMA术后更高平面截肢的独立危险因素。还获得了患者报告的功能和疼痛结局指标。
共纳入146例患者。105例患者（72%）TMA成功，41例患者（28%）需要更高平面的截肢（Lisfranc截肢：31.7%，Chopart截肢：22.0%，膝下截肢：43.9%）。随后需要近端截肢的患者术后感染发生率更高（39.0%对9.5%，P<0.001）。平均随访23.2个月（范围0.7 - 97.6个月），128例患者（87.7%）实现了肢体挽救，83%的患者（n = 121）能够行走。患者报告的功能结局平均最大功能为58.9%。疼痛调查显示，与TMA成功的患者相比，TMA失败的患者疼痛评分显著更高（P = 0.016）。
TMA的愈合情况仍存在差异，许多患者最终将需要二次近端截肢。有必要开展多机构研究以确定更高平面截肢的围手术期危险因素，并进一步评估患者报告的结局。
