What is the most durable construct for a forefoot amputation, traditional transmetatarsal amputation or a medial ray sparing procedure?

This discussion is prompted by a recent paper from Suh and colleagues from Seoul, South Korea that evaluates clinical outcomes from a retrospective cohort of 59 patients with either a traditional transmetatarsal amputation (TMA) (n=27) or first or first and second ray sparing amputation (n=32) that all required follow-up free flap coverage (1). Evaluating the function of different amputation constructs in the diabetic foot is an important issue because recurrent events are very common in patients with diabetes and a history of diabetic foot ulcer or amputation.