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Fig. 8.27 Technique for performing a transmetatarsal amputation, (a) Incision with creation of a long plantar flap, (b) Plantar view. The plantar incision is made just proximal to the sulcus of the toes. The dotted line represents the dorsal skin incision and its relationship to the metatarsal shafts, (c) Removal of the forefoot, leaving a thick myocutaneous plantar flap, (d) Resection of the metatarsals, (e, f) The plantar flap has been remodelled, approximated with the dorsal skin flap and sutured in place. The lateral view depicts how the metatarsals have been cut, from dorsal-distal to plantar-proximal. The plantar view (arrows) illustrates how the cuts are bevelled on the 1st and 5th metatarsal stumps. From Sanders (1997) with permission from Elsevier Science.

when portions of the wound remain open. Sutures are removed after 14-21 days, and the patient is then placed in a short-leg non-weightbearing fibreglass cast for an additional 3-4 weeks. The patient is then encouraged to return gradually to full weightbearing, in therapeutic low quarter depth inlay footwear. Shoe modifications include a stump filler and stiffened outer sole.

Fig. 8.28 Dry gangrene of the hallux, 2nd and 3rd toes. From Sanders (1997) with permission from Elsevier Science.

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