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Transmetatarsal amputation of the toe: An analytic study of ischemic complications
Author(s) -
Ger Ralph,
Angus George,
Scott Paul
Publication year - 1999
Publication title -
clinical anatomy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.667
H-Index - 71
eISSN - 1098-2353
pISSN - 0897-3806
DOI - 10.1002/(sici)1098-2353(1999)12:6<407::aid-ca1>3.0.co;2-4
Subject(s) - medicine , gangrene , surgery , amputation , blood supply , complication , foot (prosody) , dorsum , diabetic foot , podiatry , diabetes mellitus , anatomy , endocrinology , linguistics , philosophy , alternative medicine , pathology
Transmetatarsal amputations of the toes are very common procedures, particularly involving patients with diabetes mellitus and peripheral vascular disease. A complication of these operations is the onset of gangrene of an adjoining toe, which is usually ascribed to the underlying disease. It is suggested that another explanation may be responsible for this occurrence, namely, a combination of the variability of the bifurcation of the dorsal metatarsal arteries and the operative technique. The former is either not described or has different levels in different texts. The operation in nearly all texts is a classic racquet incision, without mention of the width of the racket. The combination of an incision widely diverging from the handle of the racket is in danger of severing the dorsal metatarsal artery, its bifurcation, or the digital branch to the adjacent toe. A patient with a good blood supply may be able to salvage the situation by way of the plantar vessels, but when the vascular status is parlous, which is the case in many amputations, the adjacent digit is at considerable risk. Clinical, radiological, and anatomic evidence is presented to support this contention. Based on the above, a safer operative technique is suggested to avoid possible complications. Clin. Anat. 12:407–411, 1999. © 1999 Wiley‐Liss, Inc.