Transmetatarsal amputation: an 8-year experience

This study retrospectively reviews an 8-year consecutive series of transmet atarsal amputation (TMA) for forefoot ischaemia in diabetic and non-diabeti c patients. Forty-one patients had TMA. Peri-operative mortality was 17% (7 /41). A healed stump was achieved in 19 patients (46%) and 18 of these pati ents were independently mobile, or mobile with sticks. Non-diabetic patient s (8/12) healed significantly better than diabetics (11/29). Median time to healing was 7 months (range 3-20 months). All non-healed survivors had a h igher amputation (14 below-knee, 1 Syme's). A healed TMA gives good mobility, but prediction of who will heal after ope ration is unreliable. Time to healing is often lengthy, and failed healing results in higher amputation. These issues need to be fully discussed with the patient who is considered for TMA.