title: Is scintigraphy a guideline method in determining amputation levels in diabetic foot?
abstract: BACKGROUND
  In this study, we aimed to evaluate the potential use of a 3-phase bone scintigraphy method to determine the level of amputation on treatment cost, morbidity and mortality, reamputation rates, and the duration of hospitalization in diabetic foot.
  
  
  METHODS
  Thirty patients who were admitted to our clinic between September 2008 and July 2009, with diabetic foot were included. All patients were evaluated according to age, gender, diabetes duration, 3-phase bone scintigraphy, Doppler ultrasound, amputation/reamputation levels, and hospitalization periods. Patients underwent 3-phase bone scintigraphy using technetium-99m methylene diphosphonate, and the most distal site of the region displaying perfusion during the perfusion and early blood flow phase was marked as the amputation level. Amputation level was determined by 3-phase bone scintigraphy, Doppler ultrasound, and inspection of the infection-free clear region during surgery.
  
  
  RESULTS
  The amputation levels of the patients were as follows: finger in six (20%), ray amputation in five (16.6%), transmetatarsal in one (3.3%), Lisfranc in two (6.6%), Chopart in seven (23.3%), Syme in one (3.3%), below-the-knee in six (20%), above the knee in one (3.3%), knee disarticulation in one (3.3%), and two patients underwent amputation at other centers. After primary amputation, reamputation was performed on seven patients, and one patient was treated with debridement for wound site problems. No mortality was encountered during study.
  
  
  CONCLUSIONS
  We conclude that 3-phase bone scintigraphy prior to surgery could be a useful method to determine the amputation level in a diabetic foot. We conclude that further, comparative, more comprehensive, long-term, and controlled studies are required.
authors.forename: Yakup Barbaros
authors.initials: YB
authors.lastname: Baykal
authors.forename: Emre
authors.initials: E
authors.lastname: Yaman
authors.forename: Halil
authors.initials: H
authors.lastname: Burc
authors.forename: Huseyin
authors.initials: H
authors.lastname: Yorgancigil
authors.forename: Tolga
authors.initials: T
authors.lastname: Atay
authors.forename: Mustafa
authors.initials: M
authors.lastname: Yıldız
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000379:methods*; D015331:Cohort Studies; D003657:Decision Making; D017719:Diabetic Foot / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D011877:Radionuclide Imaging / Q000379:methods; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017256:Technetium Tc 99m Sestamibi; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
chemical_list: D017256:Technetium Tc 99m Sestamibi