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Kouevi-Koko TE, Amouzou KS, Sogan A, Apeti S, Dakey YEL, Abalo A. Lower extremity amputations (LEAs) in a tertiary hospital in Togo: a retrospective analysis of clinical, biological, radiological, and therapeutic aspects. J Orthop Surg Res 2023; 18:155. [PMID: 36864481 PMCID: PMC9979402 DOI: 10.1186/s13018-023-03628-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/19/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND We analysed the clinical, biological, radiological profiles, and therapeutic patterns of the patients who underwent a surgical lower extremity amputation (LEA) in Togo from 2010 to 2020. METHODS Retrospective analysis of clinical files of adult patients who underwent an LEA at a single centre (Sylvanus Olympio Teaching Hospital) from 1st January 2010 to 31st December 2020. Data were analysed by CDC Epi Info Version 7 and Microsoft Office Excel 2013 software. RESULTS We included 245 cases. The mean age was 59.62 years (15.22 SD) (range: 15-90 years). The sex ratio was 1.99. The medical history of diabetes mellitus (DM) was found in 143/222 (64.41%) files. The amputation level found in 241/245 (98.37%) files was the leg in 133/241 (55.19%) patients, the knee in 14/241 (5.81%), the thigh in 83/241 (34.44%), and the foot in 11/241 (4.56%). The 143 patients with DM who underwent LEA had infectious and vascular diseases. Patients with previous LEAs were more likely to have the same limb affected than the contralateral one. The odds of trauma as an indication for LEA were twice as high in patients younger than 65 years compared to the older (OR = 2.095, 95% CI = 1.050-4.183). The mortality rate after LEA was 17/238 (7.14%). There was no significant difference between age, sex, presence or absence of DM, and early postoperative complications (P = 0.77; 0.96; 0.97). The mean duration of hospitalization marked in 241/245 (98.37%) files was 36.30 (1-278) days (36.20 SD). Patients with LEAs due to trauma had a significantly longer hospital admission than those with non-traumatic indications, F (3,237) = 5.505, P = 0.001. CONCLUSIONS Compared to previous decades, from 2010 to 2020, the average incidence of LEAs for all causes at Sylvanus Olympio Teaching Hospital (Lomé, Togo) decreased while the percentage of patients with DM who underwent LEAs increased. This setting imposes a multidisciplinary approach and information campaigns to prevent DM, cardiovascular diseases, and relative complications.
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Affiliation(s)
- T. E. Kouevi-Koko
- grid.12364.320000 0004 0647 9497Burn and Wound Healing Unit, Faculté des Sciences de la Santé, University of Lomé, Lomé, Togo ,Sylvanus Olympio Teaching Hospital, Lomé, Togo
| | - K. S. Amouzou
- grid.12364.320000 0004 0647 9497Burn and Wound Healing Unit, Faculté des Sciences de la Santé, University of Lomé, Lomé, Togo
| | - A. Sogan
- grid.12364.320000 0004 0647 9497Department of General Surgery, Faculté des Sciences de la Santé, University of Lomé, Lomé, Togo ,grid.12364.320000 0004 0647 9497Laboratory of Human Anatomy, Faculté des Sciences de la Santé, University of Lomé, Lomé, Togo
| | - S. Apeti
- grid.12364.320000 0004 0647 9497Department of Geriatrics, Faculté des Sciences de la Santé, University of Lomé, Lomé, Togo
| | - Y. E. L. Dakey
- grid.12364.320000 0004 0647 9497Burn and Wound Healing Unit, Faculté des Sciences de la Santé, University of Lomé, Lomé, Togo ,grid.12364.320000 0004 0647 9497General Surgery, Faculté des Sciences de la Santé, University of Lomé, Lomé, Togo
| | - A. Abalo
- grid.12364.320000 0004 0647 9497Traumatology-Orthopaedics Department, Faculté des Sciences de la Santé, University of Lomé, Lomé, Togo
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Tokarski AR, Barton EC, Wagner JT, Elliott AD, Simonson DC, Hordyk PJ, Rademaker M. Are Transmetatarsal Amputations a Durable Limb Salvage Option? A Single-Institution Descriptive Analysis. J Foot Ankle Surg 2022; 61:537-541. [PMID: 34794876 DOI: 10.1053/j.jfas.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 06/01/2021] [Accepted: 10/03/2021] [Indexed: 02/03/2023]
Abstract
In limb and life-threatening diabetic foot infections, transmetatarsal amputations are often indicated as a limb salvage procedure. The aim of this study is to analyze the long-term durability of initially successful transmetatarsal amputations in the diabetic population. We defined a successful transmetatarsal amputation as one which had clinical healing 1 year after surgery. A retrospective review of transmetatarsal amputations completed at our institution over an 11-year period was performed. We identified 83 amputations that met inclusion criteria. The mean follow-up was 4 years. The mean time to surgical healing was 109.8 days. After successfully healing the transmetatarsal amputation the long-term outcomes were analyzed. Re-ulcerations occurred in 44% of the transmetatarsal amputations a mean of 15 months after surgical healing. Patients who re-ulcerated were noted to be significantly younger (p value 0.02) with a significantly higher preprocedure hemoglobin A1c (p value < .001). Additional procedures after successful healing included 13 (15.66%) revision surgeries and 12 (14.46%) more proximal amputations. While transmetatarsal amputations remain a viable and durable limb preserving surgery, all patients who have undergone a transmetatarsal amputation should be monitored lifelong as they remain at risk for re-ulceration and more proximal amputation.
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Affiliation(s)
- Alexander R Tokarski
- Podiatric Medicine and Surgery Resident, Gundersen Health Systems, La Crosse, WI.
| | - Ellen C Barton
- Podiatric Medicine and Surgery Resident, Gundersen Health Systems, La Crosse, WI
| | - Jacob T Wagner
- Podiatric Medicine and Surgery Resident, Gundersen Health Systems, La Crosse, WI
| | | | | | | | - Marc Rademaker
- Undergraduate Student, University of Wisconsin-La Crosse, La Crosse, WI
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Sidon E, Shemesh S, Rosenthal Y, Heller S, Velkes S, Burg A. Medial forefoot fillet flap for primary closure of transmetatarsal amputation: A series of four cases. Foot (Edinb) 2017; 33:53-56. [PMID: 29126044 DOI: 10.1016/j.foot.2017.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 06/21/2017] [Indexed: 02/04/2023]
Abstract
Amputation of the forefoot is a salvage procedure for several forefoot acute or chronic infection. A good, sensate and durable skin cover is important for quicker and better rehabilitation. The use of filleted flaps (or "spare parts technique") has been published in the past as a creative technique. The purpose of this article is to introduce a reproducible, pre-planned, technique that requires less creativity for the use of the "spare parts". The authors describe a case series of 4 patients with deep infection and osteomyelitis of the forefoot, without involvement of the medial skin that underwent two staged procedure for transmetatarsal amputation with medial forefoot fillet flap. The first procedure was amputation of the 4 lesser metatarsal and the wound was left open. After a few days the second operation was done with amputation of the first metatarsal bone and using the filleted medial skin and subcutaneous tissue for closure of the wound. In conclusion the medial fillet flap is an effective method of covering large wounds after partial, lateral forefoot amputation. This method shortens the healing time of the patient, and in hospital stay. The authors recommend using the staged method when dealing with diabetic patients with partial, central and lateral forefoot deep infection and/or necrosis.
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Affiliation(s)
- Eliezer Sidon
- Department of Orthopedic Surgery, Rabin Medical Center, 39th Jabutinski St. Petach Tikva 49100, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
| | - Shai Shemesh
- Department of Orthopedic Surgery, Rabin Medical Center, 39th Jabutinski St. Petach Tikva 49100, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
| | - Yoav Rosenthal
- Department of Orthopedic Surgery, Rabin Medical Center, 39th Jabutinski St. Petach Tikva 49100, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
| | - Snir Heller
- Department of Orthopedic Surgery, Rabin Medical Center, 39th Jabutinski St. Petach Tikva 49100, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
| | - Steven Velkes
- Department of Orthopedic Surgery, Rabin Medical Center, 39th Jabutinski St. Petach Tikva 49100, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
| | - Alon Burg
- Department of Orthopedic Surgery, Rabin Medical Center, 39th Jabutinski St. Petach Tikva 49100, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
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Ammendola M, Sacco R, Butrico L, Sammarco G, de Franciscis S, Serra R. The care of transmetatarsal amputation in diabetic foot gangrene. Int Wound J 2016; 14:9-15. [PMID: 27696694 DOI: 10.1111/iwj.12682] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 08/26/2016] [Accepted: 09/12/2016] [Indexed: 12/19/2022] Open
Abstract
Diabetic foot ulcerations may determine minor or major amputation, with a high impact on patients' life expectation and quality of life and on economic burden. Among minor amputations, transmetatarsal amputation (TMA) appears to be the most effective in terms of limb salvage rates and in maintaining foot and ankle biomechanics. In spite of this, TMA needs particular pre- and postoperative management in order to avoid the frequent failure rates. A systematic review was undertaken of studies concerning TMA and its care in diabetic foot gangrene. Studies were identified by searching the MEDLINE, Scopus and Science Direct databases until 13 January 2016. All studies were assessed using the Downs and Black quality checklist. Of the 348 records found, 86 matched our inclusion criteria. After reading the full-text articles, we decided to exclude 35 manuscripts because of the following reasons: (1) no innovative or important content, (2) no multivariable analysis, (3) insufficient data, (4) no clear potential biases or strategies to solve them, (5) no clear endpoints and (6) inconsistent or arbitrary conclusions. The final set included 51 articles. In the current literature, there are less data about TMA, indication for the selection of patients, outcomes and complications. Generally, the judgment of an experienced physician is one of the best indicators of subsequent healing. Ankle brachial indices, toe pressures, laser Doppler skin perfusion pressures, angiography and Doppler assessment of foot vasculature may help physicians in this decision. In any case, despite the presumed lower healing rate, it is reasonable to pursue a TMA in a patient with a higher likelihood of continued ambulation. Furthermore, tailored wound closure, adjuvant local treatments and the choice of the most appropriate antibiotic therapy, when infection occurs, are pivotal elements for the success of TMA procedures. TMA is a valuable option for diabetic foot gangrene that can prevent major limb loss and minimise loss of function, thus improving the quality of life for diabetic patients.
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Affiliation(s)
- Michele Ammendola
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Rosario Sacco
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Lucia Butrico
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Giuseppe Sammarco
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Stefano de Franciscis
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.,Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Raffaele Serra
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.,Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Thorud JC, Jupiter DC, Lorenzana J, Nguyen TT, Shibuya N. Reoperation and Reamputation After Transmetatarsal Amputation: A Systematic Review and Meta-Analysis. J Foot Ankle Surg 2016; 55:1007-12. [PMID: 27475711 DOI: 10.1053/j.jfas.2016.05.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Indexed: 02/03/2023]
Abstract
Transmetatarsal amputations have generally been accepted as a relatively more definitive amputation compared with other lesser ray resections. However, many investigators have reported a high occurrence of more proximal amputation after transmetatarsal amputation. A systematic review was performed to evaluate the occurrence of reamputation and reoperation after transmetatarsal amputations. A search of the Medline, CINAHL, and Cochrane Central databases yielded 159 abstracts. After review, 24 reports were included in the study. A total of 391 (26.9%) reoperations were identified after 1453 transmetatarsal amputations. Any level reamputation occurred in 152 (29.7%) of 365 transmetatarsal amputations and major amputation occurred in 380 (33.2%) of 1146 transmetatarsal amputations. Using a random effects model, the reoperation rate was estimated at 24.43% (95% confidence interval 11.64% to 37.21%), the reamputation rate was estimated at 28.37% (95% confidence interval 19.56% to 37.19%), and the major amputation rate was estimated at 30.16% (95% confidence interval 23.86% to 36.47%). These findings raise questions about the conventional wisdom of performing primary transmetatarsal amputation in lieu of other minor amputations, such as partial first ray amputation, and suggest that the choice between transmetatarsal amputation and other minor amputations might be a decision that depends on very patient-specific factors.
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Affiliation(s)
| | - Daniel C Jupiter
- Assistant Professor, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - Jonathan Lorenzana
- Second Year Resident, Baylor Scott & White Health, Temple, TX; Section of Podiatry, Department of Surgery, Central Texas Veterans Affairs Health Care System, Temple, TX; and Department of Surgery, Texas A&M University Health and Science Center, College of Medicine, Round Rock, TX
| | | | - Naohiro Shibuya
- Associate Professor, Department of Surgery, Texas A&M University Health Science Center, College of Medicine, Round Rock, TX; Chief, Section of Podiatry, Department of Surgery, Central Texas Veterans Affairs Health Care System, Temple, TX; and Department of Surgery, Baylor Scott & White Health, Temple, TX
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Abstract
As the majority of diabetic foot ulcers are avoidable, patients with diabetes should be routinely screened for risk factors. When such factors are present, holistic assessment followed by rapid referral to the appropriate member of the multidisciplinary team will ensure that preventive measures are implemented to avoid the occurrence of ulcers. Best results will be achieved if the patient is fully involved in this process.
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Affiliation(s)
- Bahle Nteleki
- Podiatrist, Stanza Bopape Community Health Centre, Pretoria, South Africa
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Jordan DJ, Malahias M, Hindocha S, Juma A. Flap decisions and options in soft tissue coverage of the lower limb. Open Orthop J 2014; 8:423-32. [PMID: 25408784 PMCID: PMC4235066 DOI: 10.2174/1874325001408010423] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 05/03/2014] [Accepted: 05/27/2014] [Indexed: 12/18/2022] Open
Abstract
THE LOWER EXTREMITIES OF THE HUMAN BODY ARE MORE COMMONLY KNOWN AS THE HUMAN LEGS, INCORPORATING: the foot, the lower or anatomical leg, the thigh and the hip or gluteal region. The human lower limb plays a simpler role than that of the upper limb. Whereas the arm allows interaction of the surrounding environment, the legs' primary goals are support and to allow upright ambulation. Essentially, this means that reconstruction of the leg is less complex than that required in restoring functionality of the upper limb. In terms of reconstruction, the primary goals are based on the preservation of life and limb, and the restoration of form and function. This paper aims to review current and past thoughts on reconstruction of the lower limb, discussing in particular the options in terms of soft tissue coverage. This paper does not aim to review the emergency management of open fractures, or the therapy alternatives to chronic wounds or malignancies of the lower limb, but purely assess the requirements that should be reviewed on reconstructing a defect of the lower limb. A summary of flap options are considered, with literature support, in regard to donor and recipient region, particularly as flap coverage is regarded as the cornerstone of soft tissue coverage of the lower limb.
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Affiliation(s)
- Daniel J Jordan
- Department of Plastic Surgery, Whiston Hospital, Liverpool, UK L35 5DR, UK
| | - Marco Malahias
- Department of Plastic Surgery, Heart of England NHS Foundation Trust, UK
| | - Sandip Hindocha
- Department of Plastic Surgery, Whiston Hospital, Liverpool, UK L35 5DR, UK
| | - Ali Juma
- Department of Plastic Surgery, Countess of Chester Hospital, Chester, UK
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