Transmetatarsal and Lisfranc Amputation

Abstract

Midfoot amputation procedures including transmetatarsal and Lisfranc amputation are common and effective treatments of both osteomyelitis and gangrene of the forefoot and midfoot that is not amenable to individual toe or ray amputation. Midfoot amputation is ideally contained at the transmetatarsal level in an effort to optimize foot function, although a Lisfranc level amputation may be necessary for extensive forefoot gangrene or midfoot osteomyelitis. This chapter will focus on surgical indications for transmetatarsal and Lisfranc amputation including advanced techniques to achieve wound closure while providing a functional and durable foot. Use of advanced podiatric, plastic, and vascular surgical approaches allows success with TMA and Lisfranc amputation for conditions that would otherwise require leg amputation. Clinical examples are presented to highlight our surgical treatment protocols including patient selection criteria, biomechanical considerations, surgical technique tips including staging, adjunct procedures, incorporation of rotational flaps, and typical postoperative care plans.