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.