title: What Role Does Function Play in Deciding on Limb Salvage versus Amputation in Patients With Diabetes?
abstract: BACKGROUND
  Patients with diabetic foot disease are at an increased risk for lower extremity amputation (LEA), premature mortality, and reduced health-related quality of life. In the setting of chronic infection, significant tissue loss, and/or an unstable deformity, limb salvage may not be possible, and major amputation is necessary.
  
  
  METHODS
  The primary goal of this study was to review the literature with an emphasis on the functional aspects associated with successful limb salvage versus major LEA. A secondary goal was to review the epidemiology, quality of life, mortality, and energy expenditure associated with diabetic foot disease.
  
  
  RESULTS
  After major LEA, patients with diabetes are 3 times more likely to die within 1 year of surgery compared with patients who have not undergone LEA. Only two thirds of diabetic patients who undergo major LEA will ambulate with a prosthesis. This increased risk of death is not fully explained by complications of diabetes mellitus such as heart attack, stroke, or kidney failure. Preservation of lower extremity function is the primary goal of treatment, and reconstructive surgery should strive to achieve a plantigrade foot that is ulcer free and stable. Patients who have undergone successful limb salvage fear major amputation more than death. The energy costs of ambulation after LEA increase as the site of LEA becomes more proximal.
  
  
  CONCLUSIONS
  Major LEA is a devastating complication in patients with diabetes. Once amputation becomes medically necessary, preoperative evaluation with a clinic specializing in amputations is very beneficial for these patients.
authors.affiliation: Dallas, Texas; and Washington, D.C.|From the Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, and the Division of Podiatric Surgery, Department of Plastic Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center.
authors.forename: Dane K
authors.initials: DK
authors.lastname: Wukich
authors.affiliation: Dallas, Texas; and Washington, D.C.|From the Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, and the Division of Podiatric Surgery, Department of Plastic Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Raspovic
mesh_terms: D000671:Amputation, Surgical; D017719:Diabetic Foot / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D004734:Energy Metabolism; D006801:Humans; D023821:Limb Salvage; D011788:Quality of Life; D020127:Recovery of Function