Hi, everyone. Thank you so much for giving me the opportunity to present on my research that found that transmitted tarsal amputations result in higher frequency of revision surgery and higher ambulation rates than below knee amputations. Some background on my research, starting off indicating the level of the lower extremity amputation is often something that's challenging and informed by multiple factors. A problem that often arises is whether to perform a transmitted tarsal amputation, a TMA, or below knee amputation, a BKA. Transmitted tarsal amputations have benefits such as they're technically simpler, they're oftentimes faster, result in less blood loss, and preserve lower extremity length. But also, TMAs present risks such as higher rates of revision, prolonged wound healing, longer courses of antibiotics, readmissions, and repeated anesthetic exposures. The aim of our research here was to compare the need for higher level of amputation revision amputations between TMAs and BKA patients. Additionally, we wanted to recognize confounders with respect to medical comorbidities. As far as our methods go, so we first received IRB approval and we performed a retrospective analysis on patients who had undergone either a BKA or a TMA by vascular orthopedic surgeons at a single academic center between January of 2013 and May of 2021. Our primary outcomes were looking for the need of revision surgery and higher level of amputations. Secondary outcomes included things like hospital length of stay, follow-up time, ambulatory status at the last follow-up, wound status at the last follow-up, and reasons for revision surgery, if any. Demographic and medical data were also gathered. As far as our data analysis goes, descriptive variables are presented with means and standard deviations of frequencies. Continuous variables are compared using independent t-tests. Categorical variables are compared between patients undergoing either TMA or BKA with a chi-squared test. Binary logistic regression used to determine differences in need of revision and higher level amputation between TMA and BKA groups. Significantly different demographics or characteristics were added into the regression model to account for potential confounders. Statistical significance was defined as P being less than 0.05. All of our statistical analyses were performed using SPSS version 28.00. Now to the meat of our presentation, the results, starting off with demographics and characteristics. A total of 367 patients were included in our analyses. There were 293 patients in the BKA group and 74 patients in our TMA group. On average, BKA patients were younger than the TMA patients. Also, on average, hemoglobin A1c was significantly higher in the BKA group. The prevalence of peripheral arterial disease and diabetes was significantly higher in the TMA group. The prevalence of Charcot neuropathy was significantly higher in the BKA group, and there were significantly more smokers in the BKA group relative to the TMA group. All of these findings are highlighted by the blue star on the left side. Continuing with our outcomes, on univariate analysis, the TMA group had a significantly higher percentage of patients that required revision surgery and higher level of amputation compared to the BKA group. Hospital length of stay was significantly longer in the BKA group than in the TMA group as well. A significantly higher percentage of TMA patients were ambulatory on last follow-up when compared to BKA patients. Our primary outcomes were broken down by which service performed each amputation. When looking at univariate comparison between services, patients undergoing an amputation by the vascular service had a higher percentage requiring revision surgery than when performed by the orthopedic service. Similarly, vascular surgery patients had a higher percentage requiring a higher level of amputation when compared to the orthopedic surgery patients. On binary logistic regression, the only significant independent predictor of needing revision surgery was undergoing a TMA. The presence of PID trended towards significance, however. Similarly, significant independent predictors of needing higher level of amputation were undergoing TMA and presence of PID. While orthopedic and vascular services had significantly different percentages of requiring revision surgery or higher level amputations regardless of the type of amputation, surgical service did not predict the outcomes on multivariate analysis. So for our conclusions, beginning with our primary finding, TMAs result in higher rates of revision amputation and higher rate of any re-operation relative to BKA when controlling for confounding variables. TMAs also have a higher risk of re-operation and need of revision amputation. Compared to BKAs, the TMAs have a higher chance of returning patients to independent ambulation. Peripheral arterial disease has a higher risk of revision surgery and higher risk of revision surgery and higher level of amputation whether or not BKA or TMA is performed. And that concludes my presentation. Thank you so much.

transmitted tarsal amputations

below knee amputations

revision surgery

prolonged wound healing

complications