title: Minor amputation in patients with diabetes mellitus and severe foot ulcers achieves good outcomes.
abstract: OBJECTIVE
  To analyse the outcome of minor amputations (through, or distal to, the ankle joint) in patients with diabetes.
  
  
  METHODS
  All diabetic patients in a defined population undergoing one or more minor amputation between 1982 and 2006 were investigated according to a standardised protocol and were followed until final outcome (healing or death). A total of 410 consecutive amputations in 309 patients with a median age of 73 (32-93) years were identified.
  
  
  RESULTS
  In 94% of amputations, deep infection (39%) and/or gangrene (55%) was present. Severe peripheral vascular disease or critical limb ischaemia was present in 61% of amputations. 261/410 (64%) of the amputations healed at a level below the ankle joint; 69/410 (17%) healed after a re-amputation above the ankle joint; in 76/410 of amputations (19%), the patient died before healing could occur. In surviving patients, 79% of the amputations healed below the ankle. Median healing time for amputations that healed below the ankle was 26 (2-250) weeks; 21% of amputations required a re-amputation above the ankle. None of the analysed parameters excluded the possibility of healing below the ankle.
  
  
  CONCLUSIONS
  In this population-based survey, the goal of avoiding major amputation was achieved in almost two thirds of minor amputations, but at the price of long healing times. In almost all amputations, the patient had deep infection and/or gangrene. In spite of this, 64% of all amputations, and 79% of amputations in surviving patients, healed at a level below the ankle. This indicates that minor amputations in these patients are worthwhile.
  
  
  BACKGROUND
  None.
authors: Department of Orthopaedics, Skane University Hospital, Malmö, Sweden. hedvig.svensson@med.lu.se
authors: H
authors: H
authors: Svensson
authors: J
authors: J
authors: Apelqvist
authors: J
authors: J
authors: Larsson
authors: E
authors: E
authors: Lindholm
authors: M
authors: M
authors: Eneroth
mesh_terms: D000038:Abscess / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000379:methods*; D017719:Diabetic Foot / Q000601:surgery*; D005260:Female; D005734:Gangrene / Q000601:surgery; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D013548:Sweden; D016896:Treatment Outcome; D014945:Wound Healing