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Invited Critique
Sep 2011

The Elusive Search for Predictors of Healing Following Transmetatarsal AmputationComment on “Predictors of Healing and Functional Outcome Following Transmetatarsal Amputations”

Author Affiliations

Author Affiliation: Division of Vascular Surgery, Department of Surgery, UCLA (University of California, Los Angeles) School of Medicine.

Arch Surg. 2011;146(9):1009-1010. doi:10.1001/archsurg.2011.246

The role of the surgeon engaged in the treatment of patients with vascular disorders has less to do with eradication of disease and more to do with maintaining or improving quality of life for his or her patients. To that end, the goal of any limb-salvage surgery is to preserve preoperative ambulatory status. Multiple studies have demonstrated ambulation rates of less than 50% following below-knee amputation. On the contrary, a patient with a healed forefoot amputation has a high likelihood of ambulation because of the preserved mechanics of normal ambulation and the lack of need for a prosthetic. In this well-written article by Landry and colleagues,1 the group retrospectively analyzes their experience with 62 transmetatarsal amputations (TMAs) during a 6-year period, and their results validate the importance of the TMA because almost 75% of patients with healed TMA achieved ambulatory status. In addition, although not specifically addressed in the article, the time to ambulation in patients with successful TMA is generally a fraction of the time typically required for a patient with a below-knee amputation to complete the rehabilitation required to walk with a prosthetic.

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