Predictors of Healing and Functional Outcome Following Transmetatarsal Amputations

Landry, Gregory J.; Silverman, Daniel A.; Liem, Timothy K.; Mitchell, Erica L.; Moneta, Gregory L.

doi:10.1001/archsurg.2011.206

Cited by 84 publications

(71 citation statements)

References 13 publications

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“…However, none of them reported correlations on living status being a predictive characteristic of walking ability following lower extremity amputation (18,21,22,26). …”

Section: Discussionmentioning

confidence: 99%

Predicting Walking Ability Following Lower Limb Amputation: An Updated Systematic Literature Review

Highsmith²,

et al. 2016

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There is not a clear clinical recommendation for the determination of prosthetic candidacy. Guidelines do not delineate which member(s) of the multidisciplinary team are responsible for prosthetic candidacy decisions and which factors will best predict a positive outcome. Also not clearly addressed is a patient-centered decision-making role. In a previous systematic review (SR), Sansam et al. reported on the prediction of walking ability following lower limb amputation using literature up to 2007. The search strategy was designed from the previous Sansam SR as an update of previously valuable predictive factors of prosthetic candidacy. An electronic literature search was executed from August 8, 2007, to December 31, 2015, using MEDLINE (Pubmed), Embase, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) (Ovid), and Cochrane. A total of 319 studies were identified through the electronic search. Of these, 298 were eliminated, leaving a total of 21 for full evaluation. Conclusions from this updated study are drawn from a total recruited sample (n) of 15,207 subjects. A total of 12,410 subjects completed the respective studies (18% attrition). This updated study increases the size of the original Sansam et al. report by including 137% more subjects for a total of 21,490 between the two articles Etiology, physical fitness, pre-amputation living status, amputation level, age, physical fitness, and comorbidities are included as moderate to strongly supported predictive factors of prosthetic candidacy. These factors are supported in an earlier literature review and should be strongly considered in a complete history and physical examination by a multidisciplinary team. Predictive factors should be part of the patient’s healthcare record.

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“…However, none of them reported correlations on living status being a predictive characteristic of walking ability following lower extremity amputation (18,21,22,26). …”

Section: Discussionmentioning

confidence: 99%

Predicting Walking Ability Following Lower Limb Amputation: An Updated Systematic Literature Review

Highsmith²,

et al. 2016

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“…Amputation‐level decision‐making in the context of diabetes and peripheral artery disease (PAD) is extremely challenging. The preservation of mobility and its impact on quality of life are key considerations. The goal of preserving mobility has led to a focus on attempting the most distal amputation procedure possible: preserving the knee joint by performing a transtibial (TT) rather than a transfemoral (TF) amputation, or by attempting a limb salvage transmetatarsal (TM) amputation rather than a major amputation.…”

Section: Introductionmentioning

confidence: 99%

“…The preservation of mobility and its impact on quality of life are key considerations. The goal of preserving mobility has led to a focus on attempting the most distal amputation procedure possible: preserving the knee joint by performing a transtibial (TT) rather than a transfemoral (TF) amputation, or by attempting a limb salvage transmetatarsal (TM) amputation rather than a major amputation. The importance of preserving extremity length by performing more distal amputations, especially at the TM level, has been questioned because of the associated risk of healing failure and the uncertainty about potential mobility advantages.…”

Section: Introductionmentioning

confidence: 99%

Predicting reamputation risk in patients undergoing lower extremity amputation due to the complications of peripheral artery disease and/or diabetes

Czerniecki

Thompson

Littman

et al. 2019

British Journal of Surgery

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Background Patients undergoing amputation of the lower extremity for the complications of peripheral artery disease and/or diabetes are at risk of treatment failure and the need for reamputation at a higher level. The aim of this study was to develop a patient‐specific reamputation risk prediction model. Methods Patients with incident unilateral transmetatarsal, transtibial or transfemoral amputation between 2004 and 2014 secondary to diabetes and/or peripheral artery disease, and who survived 12 months after amputation, were identified using Veterans Health Administration databases. Procedure codes and natural language processing were used to define subsequent ipsilateral reamputation at the same or higher level. Stepdown logistic regression was used to develop the prediction model. It was then evaluated for calibration and discrimination by evaluating the goodness of fit, area under the receiver operating characteristic curve (AUC) and discrimination slope. Results Some 5260 patients were identified, of whom 1283 (24·4 per cent) underwent ipsilateral reamputation in the 12 months after initial amputation. Crude reamputation risks were 40·3, 25·9 and 9·7 per cent in the transmetatarsal, transtibial and transfemoral groups respectively. The final prediction model included 11 predictors (amputation level, sex, smoking, alcohol, rest pain, use of outpatient anticoagulants, diabetes, chronic obstructive pulmonary disease, white blood cell count, kidney failure and previous revascularization), along with four interaction terms. Evaluation of the prediction characteristics indicated good model calibration with goodness‐of‐fit testing, good discrimination (AUC 0·72) and a discrimination slope of 11·2 per cent. Conclusion A prediction model was developed to calculate individual risk of primary healing failure and the need for reamputation surgery at each amputation level. This model may assist clinical decision‐making regarding amputation‐level selection.

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“…The main disadvantage of this amputation is the high complication rates with the development of infection and/or ischaemia, which raise the doubt whether it is worthwhile performing TMA in patients with a diabetic foot (2,3). In fact, wound healing rates from multiple series range from approximately 40% to 70% (4).…”

Section: Introductionmentioning

confidence: 99%

Application of platelet‐rich gel to enhance healing of transmetatarsal amputations in diabetic dysvascular patients

Serra

Buffone

Dominijanni

et al. 2013

International Wound Journal

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Transmetatarsal amputation (TMA) represents an effective surgical procedure used to treat several clinical conditions such as forefoot infection, gangrene and chronic ulceration in diabetic patients. TMA permits walking without the need for prosthesis, but nevertheless is burdened with a high complications rate. The aim of this study was to evaluate the possibility to use platelet gel (PG) as an adjuvant therapy when performing TMA procedure in diabetic patients. In a 6-year period, 26 diabetic patients had undergone TMA procedure followed by autologous PG applications (group A) and 32 patients had undergone TMA as sole procedure (group B). After TMA procedure, the treatment is based on outpatient management and consists of a weekly platelet-rich plasma gel application on the surgical wound for 1 month in group A and on clinical evaluation only for group B. For group A, healing rate was of 96·15% and one patient (3·84%) presented wound dehiscence, and no postoperative wound infections occurred. For group B, healing rate was of 59·37%; severe infection of the stump prompted to the proximal amputations in 40·62% of patients during the follow-up period. PG application may be an effective adjuvant treatment to improve wound healing in diabetic dysvascular patients.

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Predictors of Healing and Functional Outcome Following Transmetatarsal Amputations

Cited by 84 publications

References 13 publications

Predicting Walking Ability Following Lower Limb Amputation: An Updated Systematic Literature Review

Predicting Walking Ability Following Lower Limb Amputation: An Updated Systematic Literature Review

Predicting reamputation risk in patients undergoing lower extremity amputation due to the complications of peripheral artery disease and/or diabetes

Application of platelet‐rich gel to enhance healing of transmetatarsal amputations in diabetic dysvascular patients

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