Augmented Closure of Surgical Wounds Reduces Complications and Limb Loss Following Transmetatarsal Amputation

Transmetatarsal amputation (TMA) is a viable option to avoid major amputation and limb loss in patients with forefoot sepsis, infection, or tissue loss [1,2]. However, TMAs are associated with significant incidence of dehiscence, re-admission, and re-operation rates of 26%-63% [3,4]. To encourage tissue healing, neovascularization, and durable closure, a resorbable, synthetic nanofiber matrix* whose architecture mimics the native human extracellular matrix, was employed in an augmented closure technique [5]. The primary objective of this study was to comparatively evaluate clinical outcomes and complication rates in TMA procedures with and without augmented closure.

A retrospective analysis of 10 patients who underwent TMA with augmented closure utilizing the synthetic nanofiber matrix* and 10 patients who underwent TMA with standard primary closure was conducted at Rush University Medical Center.  Subjects had major comorbidities including Diabetes mellitus type 2 (100%), peripheral vascular disease (50%), and end-stage renal disease (65%). Post-operative outcome measures were assessed including time to healing, incidence of major wound complications, total number of procedures, and incidence of limb loss.

Following TMA, subjects undergoing augmented and primary closure demonstrated average times to healing of 40 ± 8 days and 85 ± 52 days, respectively. Subjects undergoing augmented and primary closure demonstrated 60% and 80% incidence of major wound complications and 20% and 40% incidence of limb loss, respectively. Following TMA and augmented closure, subjects required 9 interventional procedures, compared to subjects undergoing standard closure who required 14 interventional procedures prior to complete healing.

Augmented closure of surgical wounds following TMA utilizing a synthetic nanofiber matrix* provides a unique means of reducing time to healing (47%), complications (20%), number of procedures performed (36%) and limb loss (20%)  Augmented closure therefore offers a means of improving quality of life and reducing risk for patients undergoing TMA, and potentially reducing total cost of care.

Trademarked Items (if applicable): Restrata, Acera Surgical, Inc., St. Louis, MO

References (if applicable): 1. Ammendola, Michele, et al. "The care of transmetatarsal amputation in diabetic foot gangrene." International wound journal 14.1 (2017): 9-15.
2. Pollard, Jason, et al. "Mortality and morbidity after transmetatarsal amputation: retrospective review of 101 cases." The Journal of foot and ankle surgery 45.2 (2006): 91-97.
3. Hosch J, Quiroga C, Bosma J, et al. Outcomes of transmetatarsal amputations in patients with diabetes mellitus. J Foot Ankle Surg 1997; 36: 430-4.
4. O’Brien PJ, Cox MW, Shortell CK, et al. Risk factors for early failure of surgical amputations: an analysis of 8,878 isolated lower extremity amputation procedures. J Am Coll Surg 2013; 216: 836-42; discussion, 842-4.
5. MacEwan, Matthew R., et al. "What makes the optimal wound healing material? a review of current science and introduction of a synthetic nanofabricated wound care scaffold." Cureus 9.10 (2017).