The Use of Flap Techniques to Preserve Limb Length in Patients with Transmetatarsal Amputations.

BACKGROUND:Chronic lower extremity (LE) wounds affect up to 13% of the United States population. Transmetatarsal amputation (TMA) is frequently performed in comorbid patients with chronic forefoot wounds. TMA allows limb salvage and preserves functional gait, without need for prosthesis. Traditionally, when tension-free primary closure is not possible, a higher-level amputation is performed. This is the first series to evaluate the outcomes following local and free flap coverage of TMA stumps in patients with chronic foot wounds. METHODS:A retrospective cohort of patients who underwent TMA with flap coverage from 2015-2021 were reviewed. Primary outcomes included flap success, early postoperative complications, and long-term outcomes (limb salvage and ambulatory status). Patient-reported outcome measures using the lower extremity functional scale (LEFS) were also collected. RESULTS:Fifty patients underwent 51 flap (26 local, 25 free flap) reconstructions following TMA. Average age and BMI were 58.5 years and 29.8 kg/m 2 , respectively. Comorbidities included diabetes (n=43, 86%) and peripheral vascular disease (n=37, 74%). Flap success rate was 100%. At mean follow-up of 24.8 months (range, 0.7 to 95.7 months), the limb salvage rate was 86.3% (n=44). Forty-four patients (88%) were ambulatory. The LEFS survey was completed by 24 surviving patients (54.5%). Mean LEFS score was 46.6 ± 13.9, correlating with 58.2 ± 17.4% of maximal function. CONCLUSION:Local and free flap reconstruction following TMA are viable methods of soft tissue coverage for limb salvage. Applying plastic surgery flap techniques for TMA stump coverage allows for preservation of increased foot length and ambulation without a prosthesis.