title: Syme's two-stage amputation in insulin-requiring diabetics with gangrene of the forefoot.
abstract: Thirty-five insulin-requiring adult diabetic patients underwent 38 Syme's Two-Stage amputations for gangrene of the forefoot with nonreconstructible peripheral vascular insufficiency. All had a minimum Doppler ischemic index of 0.5, serum albumin of 3.0 gm/dl, and total lymphocyte count of 1500. Thirty-one (81.6%) eventually healed and were uneventfully fit with a prosthesis. Regional anesthesia was used in all of the patients, with 22 spinal and 16 ankle block anesthetics. Twenty-seven (71%) returned to their preamputation level of ambulatory function. Six (16%) had major, and fifteen (39%) minor complications following the first stage surgery. The results of this study support the use of the Syme's Two-Stage amputation in adult diabetic patients with gangrene of the forefoot requiring amputation.
authors.affiliation: Hines Veterans Administration Hospital, Illinois.
authors.forename: M S
authors.initials: MS
authors.lastname: Pinzur
authors.forename: C
authors.initials: C
authors.lastname: Morrison
authors.forename: R
authors.initials: R
authors.lastname: Sage
authors.forename: R
authors.initials: R
authors.lastname: Stuck
authors.forename: H
authors.initials: H
authors.lastname: Osterman
authors.forename: L
authors.initials: L
authors.lastname: Vrbos
mesh_terms: D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000601:surgery*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D004188:Disarticulation / Q000379:methods / Q000534:rehabilitation; D005360:Fibula / Q000601:surgery; D005545:Forefoot, Human / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D005734:Gangrene; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D013977:Tibia / Q000601:surgery; D014945:Wound Healing