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Free Tissue Transfer after Open Transmetatarsal Amputation in Diabetic Patients

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Abstract
Background 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.

Methods 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.

Results 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.

Conclusion TMA with free flap reconstruction is an effective method for diabetic limb salvage, yielding good functional outcomes and healing results.
Author(s)
권진근박창식서현석홍준표Beatriz Hatsue Kushida-ConteraEleanor S. LumleyErin BrownIndri AuliaJulian Viste
Issued Date
2021
Type
Article
Keyword
microsurgerydiabetic footfree flap
DOI
10.1055/s-0041-1726394
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7572
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2507732857&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Free%20Tissue%20Transfer%20after%20Open%20Transmetatarsal%20Amputation%20in%20Diabetic%20Patients&offset=0&pcAvailability=true
Publisher
JOURNAL OF RECONSTRUCTIVE MICROSURGERY
Location
미국
Language
영어
ISSN
0743-684X
Citation Volume
37
Citation Number
9
Citation Start Page
728
Citation End Page
734
Appears in Collections:
Medicine > Medicine
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