Functional and Patient-reported Outcomes following Transmetatarsal Amputation in High-risk Limb Salvage Patients

Abstract

Chronic foot ulcers affect up to 13% of the United States population, and the prevalence is rising as a result of an aging and increasingly comorbid population. [1][2][3] Transmetatarsal amputation (TMA) is a limb salvage procedure for nonhealing forefoot pathologies. Current indications for a TMA include, but are not limited to, forefoot ulceration, ischemia, failed ray amputations, trauma, tumors, frostbite, and congenital deformities. 4 When successful, TMAs allow patients to maintain ambulation without a prosthesis, and at less energy expenditure than higher-level amputations. 4,5 However, TMAs have variable healing rates, reportedly ranging from 28% to 78%, and are not without risk of complications. [6][7][8] The large degree of variability in the reported rates of TMAs may be due to variations in how TMA success is defined. Some authors define "success" as closure of the wound, reepithelialization of the wound, or when the stump is able to bear weight without a prosthesis. 8 Patients whose TMA wounds do not heal will require further operations, and up to one-third of TMAs will result in major amputation. 9 Failed TMA can significantly burden patients and the healthcare system. 10 Determining the degree to which patient comorbidities and surgical