Open transmetatarsal amputation

Extensive forefoot infection or gangrene that extends on to the plantar skin may preclude a standard forefoot or mid-foot amputation. In these cases, an open or guillotine amputation performed at the mid-metatarsal level may be required. Guillotine amputations have a major disadvantage, in that they require extensive revision. A better alternative is to fashion flaps in the usual manner but to leave the wound open, with the intent to perform a delayed primary closure. The main disadvantage of open procedures is the prolonged length of time for healing, and the need for frequent dressing changes and debridement. Ideally, the wound will form a healthy granulation tissue base that can support a split-thickness skin graft or healing by secondary intention.

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