As a relatively common operation performed as an alternative to a higher limb amputation, transmetatarsal amputation (TMA) involves removing all or part of an individual’s forefoot. Its uses have become increasingly widespread, particularly for vascular conditions in which patients are suffering from infection, necrosis, gangrene and diabetic neuropathy (ulcerations). Thus, TMA surgically removes nonviable, or dead tissue, so that healing can take place.
While common, TMA is complex, as surgeons must preserve the maximum amount of midfoot to ankle distal. In other words, the length from midfoot to ankle must be carefully considered so that the individual can be properly supported and maintain functionality in their lower limb. Another critical factor is the patient’s vascular sufficiency, because this will affect the healing process. Thus, vascular surgeons may utilize Doppler ultrasound to assess perfusion and to ensure that healing can take place. In turn, the incision must be carefully planned so that enough skin is available for safe and complete closure following surgery.
For the most part, transmetatarsal amputation may be a suitable procedure for those with the following indications:
- Forefoot ulceration (that does not heal)
- Forefoot gangrene
- Diabetes mellitus (type 1 diabetes or juvenile diabetes)
- Crushed forefoot (as a result of injury or trauma)
When compared to above-knee amputations and below-knee amputations, transmetatarsal amputation represents a more logical procedure, as it is the only amputation that allows for weight bearing.
Transmetatarsal Amputation Considerations
As a form of non-traumatic lower extremity amputation (LEA), transmetatarsal amputation (TMA) is most commonly attributed to diabetes, and this number is expected to increase as the number of individuals with diabetes continues to rise. This is partially due to the higher incidence of arterial insufficiency (peripheral vascular disease) in patients with diabetes. While revascularization can certainly help with claudication and other circulation concerns, the presence of gangrene may still prove to necessitate amputation if better circulation doesn’t result in healing.
Without question, transmetatarsal amputation is a more reasonable option for patients facing the possibility of a lower limb amputation. However, approaches to treatment and ultimately surgical intervention will most likely require a multidisciplinary approach in which many factors are considered to determine the best outcome.
As a distinguished vascular and endovascular surgeon in New York City, Dr. Alan I. Benvenisty, MD, brings meticulous surgical skill and expertise to patients suffering from vascular conditions. In the case of transmetatarsal amputation, Dr. Benvenisty’s complete understanding of vascular pathology and extensive knowledge of how risk factors from pre-existing conditions affect the outcomes of surgery, work to benefit patients and ensure that every detail has been examined.
To experience conscientious and compassionate care for your vascular concerns, contact Dr. Benvenisty’s New York City office on Amsterdam Avenue today.