{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T01:13:04Z","timestamp":1788052384303,"version":"build-2784847793"},"reference-count":34,"publisher":"Georg Thieme Verlag KG","issue":"09","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Background\u2003Transmetatarsal amputation (TMA) preserves functional gait while avoiding the need for prosthesis. However, when primary closure is not possible after amputation, higher level amputation is recommended. We hypothesize that reconstruction of the amputation stump using free tissue transfer when closure is not possible can achieve similar benefits as primarily closed TMAs.<\/jats:p><jats:p>Methods\u2003Twenty-eight TMAs with free flap reconstruction were retrospectively reviewed in 27 diabetic patients with a median age of 61.5 years from 2004 to 2018. The primary outcome was limb salvage rate, with additional evaluation of flap survival, ambulatory status, time until ambulation, and further amputation rate. In addition, subgroup analysis was performed based on the microanastomosis type.<\/jats:p><jats:p>Results\u2003Flap survival was 93% (26 of 28 flaps) and limb salvage rate of 93% (25 of 27 limbs) was achieved. One patient underwent a second free flap reconstruction. In the two failed cases, higher level amputation was required. Thirteen flaps had partial loss or other complications which were salvaged with secondary intension or skin grafts. Median time until ambulation was 14 days following reconstruction (range: 9\u201320 days). Patients were followed-up for a median of 344 days (range: 142\u2013594 days). Also, 88% of patients reported good ambulatory function, with a median ambulation score of 4 out of 5 at follow-up. There was no significant difference between the subgroups based on the microanastomosis type.<\/jats:p><jats:p>Conclusion\u2003TMA with free flap reconstruction is an effective method for diabetic limb salvage, yielding good functional outcomes and healing results.<\/jats:p>","DOI":"10.1055\/s-0041-1726394","type":"journal-article","created":{"date-parts":[[2021,4,1]],"date-time":"2021-04-01T06:04:08Z","timestamp":1617257048000},"page":"728-734","source":"Crossref","is-referenced-by-count":13,"title":["Free Tissue Transfer after Open Transmetatarsal Amputation in Diabetic Patients"],"prefix":"10.1055","volume":"37","author":[{"given":"Eleanor S.","family":"Lumley","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea"},{"name":"Department of Surgery, Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Geun","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3027-3707","authenticated-orcid":false,"given":"Beatriz Hatsue","family":"Kushida-Conteras","sequence":"additional","affiliation":[{"name":"General Hospital of Mexico \u201cDr. Eduardo Liceaga,\u201d Mexico City, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea"},{"name":"Department of Plastic Surgery, University of British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Viste","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indri","family":"Aulia","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea"},{"name":"Department of Surgery, Plastic Reconstructive and Aesthetic Surgery Division, Universitas Indonesia, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changsik John","family":"Pak","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyunsuk Peter","family":"Suh","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6208-9704","authenticated-orcid":false,"given":"Joon 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