Transmetatarsal Amputation Using Calcium Sulfate Antibiotic-Loaded Pellets in Diabetic Patients

Transmetatarsal amputation is a viable alternative to below-knee amputation for patients with deep forefoot infection or skin necrosis secondary to diabetes. In the author’s experience, the main determinant of outcome is the quality of diabetic control as measured by HBA1c, not vascularity. The technique of transmetatarsal amputation is described that incorporates careful attention to soft-tissue technique and the placement of antibiotic-impregnated calcium sulfate beads (OsteoSet; Wright Medical Technologies, Memphis, TN) placed into the dead space between the skin flaps, ensuring a high local concentration of local antibiotics. This will assist infection eradication and prevent recontamination of the deep space should wound necrosis occur.