What is included in the patient preparation for transmetatarsal amputation (TMA)?

Updated: Apr 29, 2021
  • Author: Palaniappan Lakshmanan, MBBS, MS, AFRCS, FRCS(Tr&Orth); Chief Editor: Erik D Schraga, MD  more...
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Answer

TMA is performed with general anesthesia or regional anesthesia, depending on the patient's level of anesthetic risk.

The patient is placed in a supine position on the operating table, with a tourniquet around the upper thigh. A considerable amount of wool should be placed under the tourniquet cuff, and a good amount of adhesive should be applied to keep the tourniquet in place.

Full sterile preparation is undertaken with antimicrobial wash and disinfectant. The ulcerated area is covered with a surgical glove. All necessary measures for protecting the supposed healthy tissue are taken before the surgical knife is applied to the skin.

The leg is elevated, and the blood is milked out of the limb and back up the vascular tree. The tourniquet cuff is inflated, usually to a pressure of 200-300 mm Hg.


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