title: The importance of limb preservation in the diabetic population.
abstract: OBJECTIVE
  Limb salvage in the diabetic population is complex, controversial, costly and variable throughout the world. Within the diabetic population, the indications and morbidity surrounding major leg amputation have not been well defined.
  
  
  METHODS
  A retrospective study of the Georgetown Limb Salvage Registry was conducted to determine outcomes in diabetic patients undergoing proximal forefoot/midfoot (PF/M) amputations and to help define the indications for major leg amputation in ambulatory diabetic patients.
  
  
  RESULTS
  Of the 937 ambulatory diabetic patients identified during this time period, 808 who presented with superficial ulcers or distal forefoot disease and who did not go on to PF/M or higher amputation were eliminated. Records of 88 patients (92 limbs) in the PF/M amputation group and 25 patients in the below the knee amputation (BKA) group were reviewed (no above knee amputations were performed). At 2 years in the PF/M amputation group, 80% (70/88) of patients were still alive, 73% (68/92) of the limbs remained intact, and 64% of patients (56/88) were ambulatory. In contrast, in the BKA population at 2 years, 52% (13/25) of patients were deceased and 64% (16/25) were ambulating with a prosthetic limb (or had been ambulating at the time of death). The only statistically significant difference between these two groups was the presence of Charcot collapse and rear-foot disease in the BKA group.
  
  
  CONCLUSIONS
  Aggressive efforts at salvage with PF/M amputation procedures should be entertained prior to higher level amputations due to the increased morbidity and mortality evidenced.
authors: The Limb Center, Department of Plastic Surgery, Georgetown University Medical Center, 3800 Reservoir Road, N.W., Washington, DC 20007, USA. karenkim90@hotmail.com
authors: Karen Kim
authors: KK
authors: Evans
authors: Christopher E
authors: CE
authors: Attinger
authors: Ali
authors: A
authors: Al-Attar
authors: Christopher
authors: C
authors: Salgado
authors: Carrie K
authors: CK
authors: Chu
authors: Samir
authors: S
authors: Mardini
authors: Richard
authors: R
authors: Neville
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects*; D001177:Arthropathy, Neurogenic / Q000209:etiology; D001186:Artificial Limbs / Q000706:statistics & numerical data; D017719:Diabetic Foot / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000150:complications; D005260:Female; D005528:Foot / Q000601:surgery*; D005534:Foot Diseases / Q000209:etiology; D006801:Humans; D007866:Leg / Q000601:surgery*; D023821:Limb Salvage / Q000009:adverse effects*; D008297:Male; D008499:Medical Records; D051346:Mobility Limitation; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis