RESUMEN
BACKGROUND: Transmetatarsal amputation (TMA) has a reputation for failure, centred around wound breakdown. No study has looked at the direct association between the patency of individual crural arteries and the healing of TMA. TMA relies on a posterior skin flap which derives its blood supply from the posterior tibial (PT) artery. We investigated the association between PT patency and achievement of successful TMA. METHODS: A retrospective review of all patients undergoing TMA for complications of peripheral arterial occlusive disease in a regional vascular tertiary referral centre over a 9 year period (2006-2015). TMA was considered successful by the absence of a higher-level amputation. Follow-up was for a minimum of 12 months. RESULTS: 24 patients (21 male; mean age 64 years) were studied. TMA was successful in 16 (67%). On statistical analysis, successful TMA was not significantly associated with vessel patency in either superficial femoral artery (SFA), or any single or combination of named crural artery. CONCLUSION: TMA healing can be achieved in the absence of a patent posterior tibial artery. We support the role of TMA in selected patients, given its benefits compared to transtibial amputation.
Asunto(s)
Amputación Quirúrgica/métodos , Pie/cirugía , Huesos Metatarsianos/cirugía , Enfermedad Arterial Periférica/cirugía , Colgajos Quirúrgicos/trasplante , Anciano , Anciano de 80 o más Años , Amputación Quirúrgica/rehabilitación , Angiografía/métodos , Arteriopatías Oclusivas/complicaciones , Arteriopatías Oclusivas/diagnóstico por imagen , Arteriopatías Oclusivas/cirugía , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Masculino , Huesos Metatarsianos/diagnóstico por imagen , Persona de Mediana Edad , Enfermedad Arterial Periférica/complicaciones , Enfermedad Arterial Periférica/diagnóstico por imagen , Cuidados Posoperatorios/métodos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Colgajos Quirúrgicos/irrigación sanguínea , Centros de Atención Terciaria , Reino Unido , Grado de Desobstrucción Vascular/fisiología , Cicatrización de Heridas/fisiologíaRESUMEN
Background:Transmetatarsal amputation (TMA) has a reputation for failure, centred around wound breakdown. No study has looked at the direct association between the patency of individual crural arteries and the healing of TMA. TMA relies on a posterior skin flap which derives its blood supply from the posterior tibial (PT) artery. We investigated the association between PT patency and achievement of successful TMA. Methods: A retrospective review of all patients undergoing TMA for complications of peripheral arterial occlusive disease in a regional vascular tertiary referral centre over a 9 year period (20062015). TMA was considered successful by the absence of a higher-level amputation. Follow-up was for a minimum of 12 months.Results: 24 patients (21 male; mean age 64 years) were studied. TMA was successful in 16 (67%). On statistical analysis, successful TMA was not significantly associated with vessel patency in either superficial femoral artery (SFA), or any single or combination of named crural artery.Conclusion:TMA healing can be achieved in the absence of a patent posterior tibial artery. We support the role of TMA in selected patients, given its benefits compared to transtibial amputation