title: The care of transmetatarsal amputation in diabetic foot gangrene.
abstract: Diabetic foot ulcerations may determine minor or major amputation, with a high impact on patients' life expectation and quality of life and on economic burden. Among minor amputations, transmetatarsal amputation (TMA) appears to be the most effective in terms of limb salvage rates and in maintaining foot and ankle biomechanics. In spite of this, TMA needs particular pre- and postoperative management in order to avoid the frequent failure rates. A systematic review was undertaken of studies concerning TMA and its care in diabetic foot gangrene. Studies were identified by searching the MEDLINE, Scopus and Science Direct databases until 13 January 2016. All studies were assessed using the Downs and Black quality checklist. Of the 348 records found, 86 matched our inclusion criteria. After reading the full-text articles, we decided to exclude 35 manuscripts because of the following reasons: (1) no innovative or important content, (2) no multivariable analysis, (3) insufficient data, (4) no clear potential biases or strategies to solve them, (5) no clear endpoints and (6) inconsistent or arbitrary conclusions. The final set included 51 articles. In the current literature, there are less data about TMA, indication for the selection of patients, outcomes and complications. Generally, the judgment of an experienced physician is one of the best indicators of subsequent healing. Ankle brachial indices, toe pressures, laser Doppler skin perfusion pressures, angiography and Doppler assessment of foot vasculature may help physicians in this decision. In any case, despite the presumed lower healing rate, it is reasonable to pursue a TMA in a patient with a higher likelihood of continued ambulation. Furthermore, tailored wound closure, adjuvant local treatments and the choice of the most appropriate antibiotic therapy, when infection occurs, are pivotal elements for the success of TMA procedures. TMA is a valuable option for diabetic foot gangrene that can prevent major limb loss and minimise loss of function, thus improving the quality of life for diabetic patients.
authors.affiliation: Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Ammendola
authors.affiliation: Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Sacco
authors.affiliation: Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Butrico
authors.affiliation: Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sammarco
authors.affiliation: Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.|Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Catanzaro, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: de Franciscis
authors.affiliation: Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.|Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Catanzaro, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Serra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000451:nursing*; D017719:Diabetic Foot / Q000150:complications* / Q000601:surgery*; D005260:Female; D005734:Gangrene / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D008875:Middle Aged
keywords: Diabetic foot; Gangrene; Transmetatarsal amputation; Ulcer