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Gary W. Gibbons, MD; Frank C. Wheelock, Jr, MD; Carol Siembieda, RN; Carl S. Hoar, Jr, MD; John L. Rowbotham, MD; Alfred B. Persson, MD

Arch Surg. 1979;114(11):1253-1257.

Abstract
• Noninvasive laboratory testing was used to predict successful amputation levels in 150 diabetic patients. The cases of 100 patients undergoing forefoot amputation and 50 patients undergoing below-knee amputation were evaluated using segmental systolic pressures and pulse volume recordings (PVRs). The decision for and the level of amputation were based solely on clinical judgment. In patients undergoing forefoot amputation, segmental systolic pressures were falsely high or predicted incorrectly in over half the cases. Segmental PVRs were correctly predictive in only half of the cases. In patients undergoing below-knee amputation, segmental systolic pressures were falsely high or predicted incorrectly in over one third of cases. Segmental PVRs were correctly predictive in less than one third of the cases. In the diabetic patient, clinical judgment continues to provide the most accurate and reliable information by which the type of amputation and likelihood of its success can be judged.

(Arch Surg 114:1253-1257, 1979)

Author Affiliations
From the Department of Surgery, New England Deaconess Hospital and the Joslin Clinic Division, Joslin Diabetic Foundation, Boston.

Footnotes
Accepted for publication July 23, 1979.

Read before the 27th scientific meeting of the International Cardiovascular Society, Nashville, Tenn, June 28, 1979.

Reprint requests to 110 Francis St, Boston, MA 02215 (Dr Gibbons).

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