title: Influence of transmetatarsal amputation in patients requiring lower extremity distal revascularization.
abstract: When a transmetatarsal amputation (TMA) is required, successful long-term limb salvage is questioned. We evaluated the influence of TMA on limb salvage in patients undergoing lower extremity revascularization. Patients who had distal bypasses extending to the infrapopliteal arterial tree and adjunctive TMA were retrospectively reviewed. Limb salvage was determined with life-table analysis. Twenty-four patients (29 limbs) were evaluated: 15 male and 9 female. Average age was 64.2 years old. Gangrene was the indication for bypass and TMA in 25 (86.2%) patients. Seven limbs were lost to follow-up. Nine of the remaining 22 limbs required below-knee (8) or above-knee (1) amputations, seven limbs within the first 3 months. In the group of patients who had major amputations within the first 3 months, graft thrombosis was the cause of leg amputation in six (85.7%) cases. No significant predictors of early major amputation were identified. Limb salvage was 62 per cent at 1 year in the TMA group. In comparison, among historical controls requiring distal revascularization and no adjunctive toe or foot amputations, limb salvage was 76.5 per cent (P = NS). Long-term limb salvage is dependent on successful lower extremity revascularization. Requirement for TMA should not influence the decision for limb salvage.
authors.affiliation: Department of Surgery, Division of Vascular Surgery, Keck USC School of Medicine, LAC + USC Medical Center, Los Angeles, California 90033, USA.
authors.forename: Holly
authors.initials: H
authors.lastname: Glass
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Rowe
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Hood
authors.forename: Albert E
authors.initials: AE
authors.lastname: Yellin
authors.forename: Fred A
authors.initials: FA
authors.lastname: Weaver
mesh_terms: D000671:Amputation, Surgical / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005734:Gangrene; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D023821:Limb Salvage / Q000009:adverse effects / Q000379:methods; D035002:Lower Extremity / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology; D016896:Treatment Outcome