July 1985

Improved Results With Diabetic Below-Knee Amputations

Author Affiliations

From the Departments of Surgery, Harvard Medical School and New England Deaconess Hospital, Boston (Drs Fearon, Campbell, Hoar, Gibbons, Rowbotham, and Wheelock), and the Department of Surgery, Massachusetts General Hospital, Boston (Dr Wheelock).

Arch Surg. 1985;120(7):777-780. doi:10.1001/archsurg.1985.01390310015002

• This study of 100 consecutive below-knee amputations in 98 diabetic patients was undertaken to review our results and to compare them with a similar report of 20 years ago. Ninetythree limbs were ischemic, and 79% of the patients had significant infection. This finding was similar to that in our previous study group. Twenty-one percent of the patients had previous arterial reconstruction, 11% had had a toe or metatarsal amputation, and 17% required a guillotine (open) amputation to control sepsis. The below- to above-knee amputation ratio was 2.3/1. The selection of level was made on clinical grounds. None of the 100 amputations required revision to above-knee amputation. The mortality rate was 3% and the wound compllcation rate was 18%. Eighty-three percent of the patients were ambulatory at the time of discharge, which occurred at an average of 35 days. There has been a significant improvement in the number of successful below-knee amputations performed since our previous study. We attribute these results to aggressive surgical control of infection and to close follow-up with early recognition and treatment of healing problems.

(Arch Surg 1985;120:777-780)