title: Mortality and morbidity after transmetatarsal amputation: retrospective review of 101 cases.
abstract: Medical records were reviewed for 90 patients (101 amputations) (mean age 64.3 years, range 39 to 86 years) who underwent transmetatarsal amputation (TMA). The mean follow-up period, excluding those patients who either died or went on to a more proximal amputation less than 6 months after TMA, was 2.1 years. Patients were examined for any postoperative complications associated with TMA. Complications were defined as hospital mortality occurring less than 30 days postoperatively; stump infarction with or without more proximal amputation; postoperative infection; chronic stump ulceration; stump deformity in any of 3 cardinal planes; wound dehiscence; equinus and calcaneus gait. An uncomplicated outcome was defined as the absence of all these complications and an ability to walk on the residuum with a diabetic shoe and filler after a minimum follow-up of 6 months. The chi(2) tests of association were used to determine whether diabetes, a palpable pedal pulse, coronary artery disease, end-stage renal disease, cerebral vascular accident, or hypertension were predictive of or associated with healing. A documented palpable pedal pulse was a predictor of healing (P = .0567) and of not requiring more proximal amputation (P = .03). End-stage renal disease predicted nonhealing (P = .04). A healed stump was achieved in 58 cases (57.4%). Postsurgical complications developed in 88 cases (87.1%). Two patients died within 30 days postoperatively. These data suggest that TMA is associated with high complication rates in a diabetic and vasculopathic population.
authors.affiliation: Dept. of Orthopedics and Podiatric Surgery, Kaiser Permanente Medical Center, 280 W. MacArthur Boulevard, Oakland, CA 94611, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Pollard
authors.forename: Graham A
authors.initials: GA
authors.lastname: Hamilton
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Rush
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Ford
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000009:adverse effects* / Q000379:methods / Q000401:mortality*; D001424:Bacterial Infections / Q000601:surgery; D003324:Coronary Artery Disease / Q000150:complications; D017719:Diabetic Foot / Q000601:surgery; D005260:Female; D016523:Foot Ulcer / Q000601:surgery; D005734:Gangrene / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000150:complications; D007238:Infarction / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D008875:Middle Aged; D011674:Pulse; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications; D013529:Surgical Wound Dehiscence / Q000601:surgery; D014945:Wound Healing