title: Predictors of healing and functional outcome following transmetatarsal amputations.
abstract: OBJECTIVE
  To evaluate factors that predict healing and to assess functional outcome and survival following transmetatarsal amputations (TMAs) for forefoot gangrene.
  
  
  METHODS
  Retrospective case-control study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  All patients undergoing TMA from January 1, 2004, through December 31, 2010.
  
  
  METHODS
  Transmetatarsal amputations performed in all patients.
  
  
  METHODS
  Transmetatarsal amputation healing, ambulation, living status, and survival. Demographic characteristics, preoperative vascular status, and perioperative variables were analyzed as predictor variables. Univariate and multivariate analyses were performed to determine predictors of healing and survival.
  
  
  RESULTS
  Sixty-two TMAs were performed in 57 patients. Healing occurred in 33 TMAs (53%), with 22 TMAs (35%) in patients who proceeded to below-knee amputation and 7 TMAs (11%) in patients who died without healing. No demographic or perioperative variables significantly predicted healing. Independent ambulation was achieved in 24 patients with healed TMAs (73%) but in only 4 patients with nonhealed TMAs (14%) (P < .001). Mean survival was 16.5 months (range, 0-94 months), with no difference between patients with healed and those with nonhealed TMA. Significant predictors of mortality were dialysis-dependent renal failure (odds ratio, 4.85; 95% confidence interval, 1.01-23.30) (P = .047), nonindependent living (17.80; 3.03-104.80) (P = .001), and need for preoperative revascularization (4.80; 1.24-18.50) (P = .02).
  
  
  CONCLUSIONS
  Transmetatarsal amputations have low healing rates, and patient demographic characteristics and preoperative assessment do not help predict healing. Transmetatarsal amputation healing, however, significantly predicts subsequent ambulatory status and should be pursued in patients with good rehabilitation potential.
authors.affiliation: Division of Vascular Surgery, Oregon Health & Science University, Portland, OR 97239-3098, USA. landryg@ohsu.edu
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Landry
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Silverman
authors.forename: Timothy K
authors.initials: TK
authors.lastname: Liem
authors.forename: Erica L
authors.initials: EL
authors.lastname: Mitchell
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Moneta
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D000674:Amputees; D055109:Ankle Brachial Index; D016022:Case-Control Studies; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D016523:Foot Ulcer / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D005545:Forefoot, Human / Q000473:pathology* / Q000601:surgery*; D005734:Gangrene; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D017078:Laser-Doppler Flowmetry; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery; D008875:Middle Aged; D015999:Multivariate Analysis; D020127:Recovery of Function; D014945:Wound Healing