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J Reconstr Microsurg 2021; 37(09): 728-734
DOI: 10.1055/s-0041-1726394
Original Article

Free Tissue Transfer after Open Transmetatarsal Amputation in Diabetic Patients

Eleanor S. Lumley
1   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea
2   Department of Surgery, Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom
,
Jin Geun Kwon
1   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea
,
Beatriz Hatsue Kushida-Conteras 
3   General Hospital of Mexico “Dr. Eduardo Liceaga,” Mexico City, Mexico
,
Erin Brown
1   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea
4   Department of Plastic Surgery, University of British Columbia, Canada
,
Julian Viste
1   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea
,
Indri Aulia
1   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea
5   Department of Surgery, Plastic Reconstructive and Aesthetic Surgery Division, Universitas Indonesia, Jakarta, Indonesia
,
Changsik John Pak
1   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea
,
Hyunsuk Peter Suh
1   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea
,
Joon Pio Hong 
1   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea
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Abstract

Background Transmetatarsal amputation (TMA) preserves functional gait while avoiding the need for prosthesis. However, when primary closure is not possible after amputation, higher level amputation is recommended. We hypothesize that reconstruction of the amputation stump using free tissue transfer when closure is not possible can achieve similar benefits as primarily closed TMAs.

Methods Twenty-eight TMAs with free flap reconstruction were retrospectively reviewed in 27 diabetic patients with a median age of 61.5 years from 2004 to 2018. The primary outcome was limb salvage rate, with additional evaluation of flap survival, ambulatory status, time until ambulation, and further amputation rate. In addition, subgroup analysis was performed based on the microanastomosis type.

Results Flap survival was 93% (26 of 28 flaps) and limb salvage rate of 93% (25 of 27 limbs) was achieved. One patient underwent a second free flap reconstruction. In the two failed cases, higher level amputation was required. Thirteen flaps had partial loss or other complications which were salvaged with secondary intension or skin grafts. Median time until ambulation was 14 days following reconstruction (range: 9–20 days). Patients were followed-up for a median of 344 days (range: 142–594 days). Also, 88% of patients reported good ambulatory function, with a median ambulation score of 4 out of 5 at follow-up. There was no significant difference between the subgroups based on the microanastomosis type.

Conclusion TMA with free flap reconstruction is an effective method for diabetic limb salvage, yielding good functional outcomes and healing results.

Keywords

microsurgery - diabetic foot - free flap

Note

This study was presented at Abu Dhabi 10th Annual Wound Care Conference, Oral abstract presentation, March 23–24, 2019, Abu Dhabi, UAE; National Undergraduate Plastic, Reconstructive and Aesthetic Surgery Conference, Glasgow University, Poster Presentation, April 13, 2019, Glasgow, Scotland; and European Wound Management Association (EWMA) 2019 Conference, E-Poster with Short Oral Presentation, June 5–7, 2019, Gothenburg, Sweden.




Publication History

Received: 13 August 2020

Accepted: 27 January 2021

Article published online:
31 March 2021

© 2021. Thieme. All rights reserved.

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