Name of the Procedure:

Amputation, foot; transmetatarsal
Common Name(s): Transmetatarsal Amputation (TMA)

Summary

A transmetatarsal amputation is a surgical procedure where the front part of the foot (including the metatarsal bones) is removed. This is performed to address severe injuries, infections, or other conditions that cannot be managed through other treatments.

Purpose

The procedure addresses severe injuries, infections, gangrene, or complications in the front part of the foot often associated with diabetes or peripheral artery disease. The goal is to remove the damaged part to prevent the spread of disease and improve the patient's overall health and mobility.

Indications

• Severe, non-healing ulcers or infections in the foot
• Gangrene affecting the toes or forefoot
• Traumatic injuries leading to irreparable damage
• Severe peripheral artery disease
• Chronic foot pain not responsive to other treatments

Preparation

• Fasting for 6-8 hours prior to surgery
• Adjustment or temporary cessation of certain medications
• Blood tests and imaging studies (e.g., X-rays, MRI) to assess the extent of damage
• Pre-operative consultation to discuss the procedure, risks, and post-op care

Procedure Description

1. Anesthesia: Administering regional (often spinal block) or general anesthesia.
2. Incision: Making a surgical incision over the forefoot.
3. Bone Removal: Using saws and other surgical tools to remove the metatarsal bones and any necrotic tissue.
4. Closure: The surgeon closes the wound using stitches or staples and applies a sterile dressing.
5. Post-op: Applying a temporary prosthesis or protective boot to aid recovery.

Duration

The surgery typically takes about 1 to 2 hours.

Setting

The procedure is usually performed in a hospital operating room.

Personnel

• Orthopedic or vascular surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Blood clots or deep vein thrombosis (DVT)
• Poor wound healing
• Phantom limb pain
• Complications from anesthesia
• Possible need for further amputation if healing does not proceed as planned

Benefits

• Removal of painful, infected, or dead tissue
• Prevention of the spread of infection
• Improved chances of mobility with appropriate rehabilitation
• Improved overall health and quality of life

Recovery

• Initial hospital stay of a few days for monitoring
• Pain management with medications
• Keeping the surgical site clean and dry
• Physical therapy to accelerate recovery and adapt to changed gait
• Regular follow-up appointments
• Full recovery may take several weeks to months

Alternatives

• Debridement: Removal of dead tissue without full amputation.
• Antibiotic therapy for infections
• Revascularization techniques to improve blood flow
• Hyperbaric oxygen therapy
• Pros and Cons: Alternatives might preserve more of the foot but may not fully address the underlying issues, potentially delaying definitive treatment.

Patient Experience

During the procedure:

• Minimal awareness due to sedation or anesthesia.

After the procedure:

• Expected to experience discomfort or pain managed with medications.
• Physical therapy will be a critical component of recovery.
• Adaptations to new mobility patterns with assistance from healthcare providers.