What are the possible complications following a 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

Although TMA has a lower mortality than higher-level amputations do, it is not without complications, including the possibility of further surgical intervention or even death. A study conducted by Sage et al reported that more than two fifths of patients who underwent TMA had complications. [17] Another study found that nearly one third of patients who underwent TMA had a further higher-level amputation at a later date. [5] The consensus is that proximal amputations have a greater probability of stump healing.

Although some studies have failed to show a statistically significant difference in healing rate between patients who have diabetes mellitus and those who do not, risk factors such as diabetes mellitus, ischemic heart disease, hypertension, and chronic renal disease are widely considered to increase the risk of delayed healing.

However, in a study of TMA outcomes that considered several independent variables (diabetes mellitus, hemoglobin A1c >8%, neuropathy, peripheral arterial disease, chronic kidney disease, active smoking status, previous surgery, and a clean margin metatarsal bone pathology specimen positive for osteomyelitis) as possible contributors to failure to heal, only neuropathy and a positive bone margin were found to be significant. [18]

Postoperative skin breakdown probably has multiple causes; however, studies have shown that most patients who have diabetes mellitus and a TMA experience sensory neuropathy. Hence, injury to the stump in a neuropathic patient could lead to skin loss or wound failure, thus eventually resulting in infection and the need for a higher-level amputation.

Heterotopic ossification is a fairly common sequela after partial foot amputation; perioperative pharmacologic or radiation-based prophylaxis to prevent this should be considered. [19, 20]


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