Transmetatarsal amputation with excision of plantar ulcer

Chronic non-healing neuropathic plantar ulceration is often associated with the complications of soft tissue infection and osteomyelitis. Cases which are refractory to conservative care may benefit from a modified transmetatarsal amputation with excision of a triangular wedge of skin from the plantar flap. I have also employed this technique, in the absence of a plantar ulcer, to remodel excessively broad plantar flaps, thereby avoiding redundant skin and unsightly dog-ears.

Technique

Following a standard transmetatarsal amputation procedure, the plantar flap is revised as illustrated in Fig. 8.31a-e. The ulcer is completely enclosed in a triangle with its apex located proximally. Several Allis tissue forceps are applied to the distal flap and the wedge of skin is excised. It should be emphasized that the Allis clamps are only applied to skin which is to be excised. A wide malleable retractor, placed beneath the flap, provides a firm supporting surface for the excision. The two segments of the plantar flap are then approximated with absorbable simple interrupted sutures placed within the wound, and 4-0 nylon in the skin. The dorsal and plantar flaps are closed, over a TLS drain, in the usual manner (Fig. 8.32a,b). Dressings, posterior splint and cast are applied as for a basic transmetatarsal amputation.

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Responses

  • Stefan Hirsch
    How to close diabetic plantar ulcer?
    8 years ago

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