title: Syme amputation: results in patients with severe forefoot ischemia.
abstract: Since 1980, 35 patients (age range 40-77 years) with severe forefoot ischemia have undergone a unilateral Syme amputation. Thirty-one patients (89%) were diabetic. The indication for amputation was either extensive forefoot gangrene or ulceration too advanced for a digital or transmetatarsal amputation. Twenty-two amputations (63%) were immediately preceded by either percutaneous transluminal angioplasty (four) or a bypass procedure to the popliteal artery (five) or an infrapopliteal artery (13). Primary healing occurred in 19 (86%) of 22 amputations immediately preceded by revascularization and in 10 (77%) of 13 limbs undergoing amputation alone. Twenty-eight (97%) of the 29 patients with successful primary healing were successfully rehabilitated. Rehabilitation rendered 13 patients fully ambulatory, 15 ambulatory with intermittent use of a walker or cane and one unable to walk. At follow-up of four months to 13 years (mean 42 months), the cumulative ambulatory rate at 1, 3, and 5 years was 92, 80 and 80%, respectively. Syme amputation allows a return to a functional ambulatory status in a high percentage of patients with severe forefoot ischemia. These findings suggest that Syme amputation is an acceptable option in dysvascular patients with severe forefoot ischemia.
authors.affiliation: Department of Surgery, University of Southern California School of Medicine, Los Angeles, USA.
authors.forename: F A
authors.initials: FA
authors.lastname: Weaver
authors.forename: J G
authors.initials: JG
authors.lastname: Modrall
authors.forename: S
authors.initials: S
authors.lastname: Baek
authors.forename: F
authors.initials: F
authors.lastname: Harvey
authors.forename: A
authors.initials: A
authors.lastname: Siegal
authors.forename: J
authors.initials: J
authors.lastname: Rosental
authors.forename: A E
authors.initials: AE
authors.lastname: Yellin
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000379:methods* / Q000534:rehabilitation; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000534:rehabilitation / Q000601:surgery / Q000628:therapy; D002183:Canes; D017719:Diabetic Foot / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005534:Foot Diseases / Q000601:surgery; D016523:Foot Ulcer / Q000601:surgery; D005545:Forefoot, Human / Q000098:blood supply*; D005734:Gangrene / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000534:rehabilitation / Q000601:surgery* / Q000628:therapy; D008124:Locomotion; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery; D015424:Reperfusion; D016896:Treatment Outcome; D014853:Walkers; D014945:Wound Healing