Long-term Outcomes Of Reconstruction After Partial Foot Amputations Using Free Tissue Transfer
Romina Deldar, MD1, Zoe Haffner, BS2, Stephanie Shin, BS2, Parhom Towfighi, BS2, Christopher E. Attinger, MD1, Karen K. Evans, MD1.
1MedStar Georgetown University Hospital, Washington, DC, USA, 2Georgetown University School of Medicine, Washington, DC, USA.
PURPOSE: In patients with foot wounds, functional partial foot amputations (PFA), such as a transmetatarsal amputation, can preserve foot length and functional gait and avoid a below-knee amputation (BKA). When soft tissue is lacking, more proximal amputation has traditionally been performed. We evaluate the surgical and functional outcomes of using free tissue transfer (FTT) for soft-tissue coverage to preserve a functional foot amputation level to avoid BKA.
METHODS: A retrospective review of patients who underwent FTT after PFA from 2011-2021 was conducted. Primary outcomes included flap success, complications, post-operative ambulatory status, and limb salvage.
RESULTS: Thirty-eight cases were identified. Average age and BMI were 57.0 years and 27.1kg/m2, respectively. Comorbidities included diabetes (78.9%) and peripheral vascular disease (PVD) (51.4%). Immediate microsurgical success rate was 94.7%. Overall limb salvage rate was 81.6% at mean follow-up of 23.8 months (range 2.2-63.0 months). Infection and partial flap necrosis after FTT were significantly higher in patients who required eventual BKA (OR:10.4, p=0.014; OR: 9.0, p=0.010, respectively). A higher percentage of the limb salvage group was ambulatory compared to the BKA group (79.4% vs 28.6%, p=0.004).CONCLUSION: FTT to save a functional PFA level may be preferable over BKA and offer long term limb salvage. Larger studies are necessary to further elucidate which patients should be considered for PFA with FTT versus a more proximal amputation initially.
| Variable | Total | Flap Success | Flap Loss | p-value | Limb Salvage | BKA | p-value |
| Overall | 38 | 36 (94.7%) | 2 (5.3%) | 31 (81.6%) | 7 (18.4%) | ||
| Age (y) | 57.0+11.1 | 57.6+11.0 | 46.0+8.5 | 0.151 | 57.7+11.0 | 54.1+11.7 | 0.454 |
| PVD | 20 (52.6%) | 18 (50%) | 2 (100%) | 0.488 | 16 (51.6%) | 4 (57.1%) | 0.563 |
| Diabetes | 30 (78.9%) | 28 (77.8%) | 2 (100%) | 1.000 | 23 (74.2%) | 7 (100%) | 0.212 |
| Preoperative Angiogram intervention | 12 (31.6%) | 12 (33.3%) | 0 (0%) | 0.462 | 11 (35.5%) | 1 (14.3%) | 0.276 |
| Fasciocutaneous Flap type | 21 (55.3%) | 21 (58.3%) | 0 (0%) | 0.193 | 21 (67.7%) | 0 (0%) | 0.002 |
| Infection | 11 (28.9%) | 10 (27.8%) | 1 (50%) | 0.501 | 6 (19.4%) | 5 (71.4%) | 0.014 |
| Partial Flap Necrosis | 8 (21.1%) | 7 (19.4%) | 1 (50%) | 0.302 | 4 (12.9%) | 4 (57.1%) | 0.010 |
| Ambulatory | 29 (76.3%) | 28 (77.8%) | 1 (50%) | 0.422 | 27 (79.4%) | 2 (28.6%) | 0.004 |
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