Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Wound Repair Regen. 2024 Mar-Apr;32(2):182-191. doi: 10.1111/wrr.13143. Epub 2024 Jan 20.
Transmetatarsal amputation (TMA) is a common surgical procedure for addressing severe forefoot pathologies, such as peripheral vascular disease and diabetic foot infections. Variability in research methodologies and findings within the existing literature has hindered a comprehensive understanding of healing rates and complications following TMA. This meta-analysis and systematic review aims to consolidate available evidence, synthesising data from multiple studies to assess healing rates and complications associated with closed TMA procedures. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a systematic search of Medline, Embase, and Cochrane databases was conducted for articles published from January 1st, 1988, to June 1st, 2023. Inclusion criteria comprised studies reporting healing rates in non-traumatic transmetatarsal amputation patients with more than 10 participants, excluding open TMAs. Two independent reviewers selected relevant studies, with disagreements resolved through discussion. Data extracted from eligible studies included patient demographics, healing rates, complications, and study quality. Among 22 studies encompassing 1569 transmetatarsal amputations, the pooled healing rate was 67.3%. Major amputation rates ranged from 0% to 55.6%, with a random-effects pooled rate of 23.9%. Revision rates varied from 0% to 36.4%, resulting in a pooled rate of 14.8%. 30-day mortality ranged from 0% to 9%, with a fixed-effects pooled rate of 2.6%. Post-operative infection rates ranged from 3.0% to 30.7%, yielding a random-effects pooled rate of 16.7%. Dehiscence rates ranged from 1.7% to 60.0%, resulting in a random-effects pooled rate of 28.8%. Future studies should aim for standardised reporting and assess the physiological and treatment factors influencing healing and complications.
经跖骨截肢术（TMA）是一种常见的外科手术，用于治疗严重的前足病变，如周围血管疾病和糖尿病足感染。现有文献中研究方法和发现的变异性阻碍了对 TMA 后愈合率和并发症的全面理解。本 meta 分析和系统回顾旨在整合现有证据，综合多项研究的数据，评估闭合 TMA 手术相关的愈合率和并发症。根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，对 1988 年 1 月 1 日至 2023 年 6 月 1 日发表的文章进行了 Medline、Embase 和 Cochrane 数据库的系统搜索。纳入标准包括报告非创伤性经跖骨截肢患者愈合率的研究，患者人数超过 10 例，不包括开放性 TMA。两名独立的审查员选择了相关的研究，通过讨论解决分歧。从合格研究中提取的数据包括患者人口统计学、愈合率、并发症和研究质量。在纳入的 22 项研究中，共包括 1569 例经跖骨截肢，总的愈合率为 67.3%。主要截肢率范围为 0%至 55.6%，随机效应合并率为 23.9%。翻修率从 0%到 36.4%不等，合并率为 14.8%。30 天死亡率从 0%到 9%不等，固定效应合并率为 2.6%。术后感染率范围为 3.0%至 30.7%，随机效应合并率为 16.7%。裂开率范围为 1.7%至 60.0%，随机效应合并率为 28.8%。未来的研究应旨在实现标准化报告，并评估影响愈合和并发症的生理和治疗因素。
