Surgical outcomes of forefoot amputations on 122 patients and the role of random fasciocutaneous flaps in forefoot infections and revision surgery: A retrospective analysis

Abstract

Deep tissue coverage in the management of high-risk limb salvage cases poses a challenge to surgeons. Local fasciocutaneous flaps are utilized for coverage of forefoot amputations when the soft tissue equilibrium does not permit primary closure. The aim of this study is to report the mid-term safety and efficacy outcomes of patients who underwent fasciocutaneous flap for limb salvage and analyze the base procedures recruited for partial ray and transmetatarsal amputations.

A review of 122 consecutive patients who underwent forefoot amputation between May 2016 and December 2021 with a minimum of 12 months follow-up was performed. Fasciocutaneous flap closure was recruited in 21 patients (17%), all of whom demonstrated successful wound closure with a mean follow-up period > 3 years (range 19 to 67 months). The Incidence of recurrent breakdown following transmetatarsal amputation (TMA) was 11 limbs (15.4%), and below-the-knee (BKA) incidence was 7 limbs (9.8%), with a 90% limb salvage rate. In this cohort, the risk of breakdown is 112.3% higher when comparing a partial ray amputation to a TMA.

At a mean follow-up greater than 3 years, the incidence of recurrent breakdown resulting in higher-level amputation was no different between closure via random fasciocutaneous flap (9.5%) and traditional closure methods (9.8%). These outcomes justify using fasciocutaneous flaps for closure and the procedures they're indicated for, such as a TMA. They provide a reliable option while maintaining the integrity of local tissue needs, with minimal morbidity, from an expendable donor site while attaining primary wound closure.