Evaluation of the Outcome of Trans metatarsal Amputation in Diabetic Patients

Abstract

Single or multiple toes amputation in diabetic patients with Back ground forefoot gangrene or infection is usually associated with residual infection or ulceration in the remaining toes, Trans metatarsal amputation (TMA) is a viable alternative when performed properly in well-selected patients. It has the advantage of easy lodging of footwear & potentially better functional outcome. Aims of study to evaluate the outcome of TMA in diabetic foot in terms of healing potential, complications, function and patient satisfaction and to put guides to the indications and contraindications of the procedure in diabetic patients. This prospective case study was carried out at Basra Teaching Hospital during the period from October 2016 until December 2018. Total numbers of 25 diabetic patients with 26 feet with forefoot gangrene, infection or ulcer were registered in the study. A total number of 26 feet in 25 diabetic patients were included in the study. Their ages ranged from 38-70 years (mean age 56.2 years). Males were more predominant than females (80% versus 20%). Peripheral neuropathy was present in all patients. Sixteen patients (64%) had type I diabetes versus 9 patients (36%) were type II diabetics. The average healing time was 13.3 weeks (ranged from 3-20 weeks). Failure of TMA & conversion into a below knee amputation was recorded in 3 feet (11.5%). Transmetatarsal amputation (TMA) is a valuable salvage procedure for treatment of forefoot gangrene & infection in well selected diabetic patients. Wound healing is highly unpredicted & not affected by presence or absence of comorbidities. Rehabilitation is promising & all patients with successful TMA were satisfied with their ability for independent walking after a reasonable period of time.