Ammendola M, Sacco R, Butrico L, et al: The care of transmetatarsal amputation in diabetic foot gangrene. Int Wound J 14: 9, 2017.
Pollard J, Hamilton G, Rush S, et al: Mortality and morbidity after transmetatarsal amputation: retrospective review of 101 cases. J Foot Ankle Surg 45: 91, 2006.
Fakorede F: Increasing awareness this national diabetes month can save limbs and lives. AJMC Web site. Available at: https://www.ajmc.com/view/increasing-awareness-this-national-diabetes-month-can-save-limbs-and-lives. Published November 29, 2018.
Thorud J, Plemmons B, Buckley C, et al: Mortality after nontraumatic major amputation among patients with diabetes and peripheral vascular disease: a systematic review. J Foot Ankle Surg 55: 591, 2016.
Jupiter D, Throud J, Buckley C, et al: The impact of foot ulceration and amputation on mortality in diabetic patients: I. From ulceration to death, a systematic review. Int Wound J 13: 892, 2016.
Thorud JC, Seidel JL: A closer look at mortality after lower extremity amputation. Podiatry Today 3: 12, 2018.
Thomas SR, Perkins JM, Magee TR, et al: Transmetatarsal amputation: an 8-year experience. Ann R Coll Surg Engl 83: 164, 2011.
O'Brien P, Cox M, Shortell C, et al: Risk factors for early failure of surgical amputations: an analysis of 8,878 isolated lower extremity amputation procedures. J Am Coll Surg 216: 836, 2013.
Hosch J, Quiroga C, Bosma J, et al: Outcomes of transmetatarsal amputations in patients with diabetes mellitus. J Foot Ankle Surg 36: 430, 1997.
Wallace GF, Stapleton JJ: Transmetatarsal amputations. Clin Podiatr Med Surg 22: 365, 2005.
Clark GD, Lui E, Cook KD: Tendon balancing in pedal amputations. Clin Podiatr Med Surg 22: 447, 2005.
Landry G, Silverman D, Liem T, et al: Predictors of healing and functional outcome following transmetatarsal amputations. Arch Surg 146: 1005, 2011.
MacEwan M, MacEwan S, Kovacs T, et al: What makes the optimal wound healing material? a review of current science and introduction of a synthetic nanofabricated wound care scaffold. Cureus 9: e1736, 2017.
McKittrick LS, McKittrick JB, Risley TS: Transmetatarsal amputation for infection or gangrene in patients with diabetes mellitus. Ann Surg 130: 826, 1949.
Dudkiewicz I, Schwarz O, Heim M, et al: Trans-metatarsal amputation in patients with a diabetic foot: reviewing 10 years experience. Foot 19: 201, 2009.
MacEwan MR, MacEwan S, Wright AP, et al: Comparison of a fully synthetic electrospun matrix to a bi-layered xenograft in healing full thickness cutaneous wounds in a porcine model. Cureus 9: e1614, 2017.
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.