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Assessment of a Novel Augmented Closure Technique for Surgical Wounds Associated with Transmetatarsal Amputation: A Preliminary Study

Jeffery AlexanderPodiatry Section, Department of Orthopedic Surgery, Rush University Medical Center, Oak Park, IL

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Vishal DesaiPodiatry Section, Department of Orthopedic Surgery, Rush University Medical Center, Oak Park, IL

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Sharif DendenPodiatry Section, Department of Orthopedic Surgery, Rush University Medical Center, Oak Park, IL

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Nicholas AlianelloPodiatry Section, Department of Orthopedic Surgery, Rush University Medical Center, Oak Park, IL

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Background: Transmetatarsal amputation (TMA) is a viable option to avoid major amputation and limb loss in patients with forefoot sepsis, infection, or tissue loss. However, TMAs are associated with a significant incidence of dehiscence, readmission, and reoperation rates ranging from 26% to 63%. To encourage tissue healing, neovascularization, and durable closure, a nonwoven, resorbable, synthetic hybrid-scale fiber matrix whose architecture is similar to native human extracellular matrix was used in an augmented closure technique. We comparatively evaluated clinical outcomes and complication rates in TMA procedures with and without augmented closure.

Methods: A retrospective analysis of ten patients who underwent TMA with augmented closure using the synthetic matrix and ten patients who underwent TMA with standard primary closure was conducted.

Results: After TMA, 80% of the patients who underwent augmented closure demonstrated complete wound healing compared with 60% of the control group. Patients undergoing augmented closure demonstrated five instances of wound dehiscence and 20% limb loss compared with eight instances of wound dehiscence and 40% limb loss in the control group. After TMA and augmented closure, patients required eight interventional procedures before complete healing compared with patients undergoing standard closure, who required 13 interventional procedures before complete healing.

Conclusions: Augmented closure of surgical wounds after TMA using a synthetic hybrid-scale fiber matrix provided a unique means of reducing time to healing (18%), wound dehiscence (29%), number of procedures performed (39%), and rate of limb loss (20%). Augmented closure, therefore, offers a means of improving quality of life and reducing risk for patients undergoing TMA, and potentially reducing total cost of care.

Corresponding author: Jeffery Alexander, DPM, Podiatry Section, Department of Orthopedic Surgery, Rush University Medical Center, 610 S Maple Ave, #2550, Oak Park, IL 60304. (E-mail: jeffery_alexander@rush.edu)