OUTCOME REVIEW OF TRANSMETATARSAL AMPUTATIONS IN DIABETIC PATIENTS USING ANTIBIOTIC PELLETS

Abstract

Introduction and Aims: The transmetatarsal amputation (TMA) is a limb-saving alternative to below knee amputation (BKA) for diabetic patients with forefoot infections. The purpose of this study was to retrospectively review the outcomes of diabetic patients who received a TMA for a non-healing ulcer of the forefoot with or without insertion of antibiotic beads into the surgical wound.

Method: Sixty-five diabetic patients were treated for forefoot ulcers by a single stage TMA and 49 of these patients had insertion of antibiotic pellets into the wound during surgery. A comprehensive chart review was conducted on all patients to gather information on patient age at amputation, sex, smoking, type of diabetes, use of osetoset, time to wound healing, debridement before and after TMA, duration of ulcer prior to TMA, hemoglobin level at time of TMA, HbA1C, presence of heel ulcer, prior ipsilateral toe amputation, pulse status prior to TMA, vascular reconstruction and presence of unreconstructable vascular problem. Outcome follow-up using validated functional outcome questionnaires was completed in 85% of TMA patients.

Results: Healing time was approximately 18 weeks in the antibiotic pellet group, with a BKA rate of 25%. This is in contrast to the literature values of healing times (not isolated to diabetes) for a TMA of 28 weeks and BKA rates of 34–40%. The antibiotic pellet group scored higher than average for bodily pain; social function; role emotional and mental health on the SF-36.

Conclusion: The reduction in time to wound healing and decrease in BKA rates suggests inserting antibiotic pellets into the surgical wound can improve the outcomes of TMAs for patients with non-healing diabetic ulcers of the forefoot. This new procedure could have a significant impact on the management of diabetic foot ulcers by offering an effective limb-saving alternative to the commonly used BKA procedure.