The Syme amputation: success in elderly diabetic patients with palpable ankle pulses.
The Syme amputation is an old operation that has been used during this century primarily as a means of treating traumatic injuries to the forefoot in military patients. In 1984 we made a deliberate attempt to perform the operation in a highly selective group of dysvascular patients with forefoot necrosis who happened to have a palpable posterior tibial pulse. We reviewed the charts of 26 patients who underwent a one-stage (3 patients) or two-stage (23 patients) Syme amputation. The mean age was 60 years, (range 32 to 74 years). There were 17 insulin-dependent diabetic patients, and 3 diet-controlled diabetic patients. Twenty-two patients (85%) had a palpable posterior tibial pulse before surgery. Fourteen patients (54%) underwent a preliminary Ray (4) or transmetatarsal (10) amputation to rid the forefoot of an active infection. Overall, 20 patients (77%) had successful Syme amputations. Nineteen of 22 patients (85%) with a palpable posterior tibial pulse had a successful amputation in contrast to one out of four patients (25%) who did not have a palpable pulse before surgery (p = 0.04). The mean follow-up of all patients was 23 months. The durability of the operation was demonstrated in finding that only one patient in 20 initially successful Syme amputations required revision to the below-knee level. The two-stage Syme amputation can be a very gratifying operation with success rates approaching 85%, even if offered to elderly diabetic patients. The single most important feature for success is to limit the operation to those patients with a palpable posterior tibial pulse before operation.
Francis
H
H
Department of Surgery, University of Texas Southwestern Medical Center, Dallas.
Roberts
J R
JR
Clagett
G P
GP
Gottschalk
F
F
Fisher
D F
DF
D000671:Amputation, Surgical / Q000379:methods*; D000842:Ankle / Q000098:blood supply; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003925:Diabetic Angiopathies / Q000601:surgery*; D003929:Diabetic Neuropathies / Q000601:surgery*; D005534:Foot Diseases / Q000209:etiology / Q000601:surgery*; D005545:Forefoot, Human / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011674:Pulse