Evaluation of Closure Materials on Outcomes Following Transmetatarsal Amputation: A Retrospective Review.

BACKGROUND: Transmetatarsal amputation (TMA) is an important limb-salvage procedure for foot infection and ischemia but is associated with variable healing rates and postoperative complications. While patient-specific risk factors have been well described, the impact of closure material on wound and infection outcomes remains poorly defined. PURPOSE: To evaluate whether external closure material influences postoperative wound complications or infection following TMA. STUDY DESIGN: Level 3 retrospective comparative study. METHODS: A retrospective review was conducted of 108 patients who underwent primary TMA between 2013 and 2022 across four hospitals. Associations between closure materials and postoperative wound complications or infection were evaluated. Patient characteristics, including diabetes and vascular status, as well as secondary outcomes such as pain, proximal amputation, and contralateral amputation, were analyzed. Fisher's exact test and logistic regression were used for statistical analysis. RESULTS: Wound complications occurred in 70 patients (65%), and postoperative infection in 10 patients (9%). No statistically significant differences in wound risk were observed among closure materials (nylon p = 0.061, staples p = 0.165, polypropylene p = 0.990). Infection rates similarly did not differ by closure material (nylon p = 0.058, staples p = 0.990, polypropylene p = 0.990). Multivariable regression confirmed no external closure material-specific association with wound or infection outcomes. Wound and infection occurrence were not significantly associated with secondary postoperative outcomes. CONCLUSIONS: No significant association between external closure material and postoperative wound or infection outcomes was detected in this cohort. Larger studies are needed to evaluate the influence of closure material on postoperative outcomes. LEVEL OF CLINICAL EVIDENCE: Level 3 Retrospective Comparative.