This anatomical plate, displayed in a hypothetical journal format, was created after observing transmetatarsal amputation surgeries at Johns Hopkins Hospital. During a transmetatarsal amputation, the forefoot is removed halfway down the length of the metatarsal bones. The surgery depicted here is a guillotine amputation, meaning no skin was preserved for a skin flap. Initial sketches were made during the surgery and refined after consultation with the attending surgeons.
Sketches
A deep circumferential incision is made just proximal to the affected area.
The metatarsophalangeal joints are disarticulated.
Collateral ligaments are severed and periosteum is removed from metatarsals.
Metatarsals are cut with a sagittal saw angled inferiorly. Flexor tendons are severed with a scalpel and the bone is removed from the field.
The wound is debrided until no gangrenous tissue remains.
The wound is irrigated with saline solution.
A running locking suture coapts dorsal and plantar intrinsic muscle layers to create a muscular sling over exposed bone.
Figure-of-eight sutures reapproximate the dorsal and plantar flaps. Skinplasties performed at the medial and lateral edges of the wound.
Skinplasty closed with a running locking suture.
Cod skin graft is prepared to be attached via two simple interrupted sutures in contralateral corners and then a running locking suture around all four edges.
The running locking suture adheres the skin graft to the edge of the wound.
The completed procedure.
Diagram depicts angle of cut bones, allowing for ease of ambulation.
