title: Reoperation and Reamputation After Transmetatarsal Amputation: A Systematic Review and Meta-Analysis.
abstract: Transmetatarsal amputations have generally been accepted as a relatively more definitive amputation compared with other lesser ray resections. However, many investigators have reported a high occurrence of more proximal amputation after transmetatarsal amputation. A systematic review was performed to evaluate the occurrence of reamputation and reoperation after transmetatarsal amputations. A search of the Medline, CINAHL, and Cochrane Central databases yielded 159 abstracts. After review, 24 reports were included in the study. A total of 391 (26.9%) reoperations were identified after 1453 transmetatarsal amputations. Any level reamputation occurred in 152 (29.7%) of 365 transmetatarsal amputations and major amputation occurred in 380 (33.2%) of 1146 transmetatarsal amputations. Using a random effects model, the reoperation rate was estimated at 24.43% (95% confidence interval 11.64% to 37.21%), the reamputation rate was estimated at 28.37% (95% confidence interval 19.56% to 37.19%), and the major amputation rate was estimated at 30.16% (95% confidence interval 23.86% to 36.47%). These findings raise questions about the conventional wisdom of performing primary transmetatarsal amputation in lieu of other minor amputations, such as partial first ray amputation, and suggest that the choice between transmetatarsal amputation and other minor amputations might be a decision that depends on very patient-specific factors.
authors.affiliation: Podiatrist, Mercy Health, McHenry, IL. Electronic address: jakethorud@gmail.com.
authors.forename: Jakob C
authors.initials: JC
authors.lastname: Thorud
authors.affiliation: Assistant Professor, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Jupiter
authors.affiliation: Second Year Resident, Baylor Scott & White Health, Temple, TX; Section of Podiatry, Department of Surgery, Central Texas Veterans Affairs Health Care System, Temple, TX; and Department of Surgery, Texas A&M University Health and Science Center, College of Medicine, Round Rock, TX.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lorenzana
authors.affiliation: Surgeon, The Foot Doctors of Santa Cruz, CA.
authors.forename: Tea Tu
authors.initials: TT
authors.lastname: Nguyen
authors.affiliation: Associate Professor, Department of Surgery, Texas A&M University Health Science Center, College of Medicine, Round Rock, TX; Chief, Section of Podiatry, Department of Surgery, Central Texas Veterans Affairs Health Care System, Temple, TX; and Department of Surgery, Baylor Scott & White Health, Temple, TX.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Shibuya
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects* / Q000379:methods; D017719:Diabetic Foot / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D008875:Middle Aged; D011379:Prognosis; D012086:Reoperation / Q000379:methods* / Q000706:statistics & numerical data; D018570:Risk Assessment; D012720:Severity of Illness Index; D014945:Wound Healing / Q000502:physiology
keywords: diabetic foot; limb salvage; midfoot amputation; minor amputation; peripheral vascular disease