Transmetatarsal amputation
D. J. Effeney, R. C. Lim and W. P. Schecter
We have reviewed the records of 25 patients who underwent a transmetatarsal
amputation at San Francisco General Hospital. The average patient age was
63 years old. Twelve of the patients were diabetic, while transmetatarsal
amputations were performed in eleven with simple arteriosclerosis. Two
patients underwent amputations for either trauma or nonhealing ulcer.
Thirteen of the patients healed their amputation, and twelve of these
became ambulatory. Eleven required higher amputation, because of nonhealing
due to infection in seven and progressive ischemia in four. One patient
died on the first postoperative day of pneumonia. The failure group was
younger, contained more diabetics, and had a higher incidence of infection.
The operative procedure of transmetatarsal amputation is described. We
believe that patients with distal gangrene without spreading infection
should be considered for transmetatarsal amputation, reserving initial
below-knee amputation for those with greater involvement of the foot.
