Improved results with diabetic below-knee amputations
J. Fearon, D. R. Campbell, C. S. Hoar Jr, G. W. Gibbons, J. L. Rowbotham and F. C. Wheelock Jr
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. Ninety-three 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
complication 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.
