Minor foot amputation trial opens
Toe amputation is a common vascular surgical procedure. Re-amputation rates are high, approaching 50%. Numerous studies have evaluated patient-level factors which may predict amputation failure but there is a dearth of evidence examining the impact of surgical technique on outcomes following this common procedure.
Traditionally, surgeons achieve division of the metatarsal with a bone cutter rather than a bone saw. However, use of bone cutters is subject to inter-operator variability (some surgeons are stronger than others). Improperly applied forces through the bone cutter may fracture residual bone. This leads to small comminuted fragments which may act as a nidus of later infection in the wound bed. An oscillating microsaw eliminates the operator effect, providing a clean transection regardless of operator although it may cause more damage to surrounding tissue.
A systematic review identified no trials comparing bone cutters to oscillating bone saw for metatarsal transection in diabetic toe amputation. MetaMet is a randomised feasibility trial to inform the design of a potential definitive trial of the two techniques. Sponsored by RCSI, with support from the Diabetes Clinical Trial Network and the National Surgical Research Support Centre, MetaMet has opened recruitment at Galway University Hospital and is due to open shortly at Tallaght University Hospital.