Open transmetatarsal amputation in the treatment of severe foot infections

Joseph R. Durham, David M. McCoy, Alan P. Sawchuk, Joseph P. Meyer, Thomas H. Schwarcz, Jens Eldrup-Jorgensen, D. Preston Flanigan, James J. Schuler

Research output: Contribution to journalArticlepeer-review

40 Scopus citations


Severe forefoot infections may lead to limb loss, even if addressed aggressively. Infection or gangrene that compromises the plantar skin flap may preclude a standard transmetatarsal or midfoot amputation, thereby culminating in a below-knee amputation. We report a series of forefoot infections with loss of the distal plantar skin. Open or guillotine amputation at the mid-metatarsal level led to a high rate of healing and a durable stump, provided that the level of infection did not extend beyond the metatarsal heads. Wound closure was obtained by wound contracture alone or by use of partial-thickness skin grafting. Rehabilitation was dependable. The association of diabetes mellitus or gangrene did not adversely affect outcome. Open transmetatarsal amputation is a safe surgical option preferable to midfoot or below-knee amputation for the treatment of severe forefoot infection that does not extend proximally beyond the metatarsal heads.

Original languageEnglish (US)
Pages (from-to)127-130
Number of pages4
JournalThe American Journal of Surgery
Issue number2
StatePublished - Aug 1989
Externally publishedYes

ASJC Scopus subject areas

  • Surgery

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