The clinical course of diabetics who require emergent foot surgery because of infection or ischemia.

For the past 15 years at our institution, all acute diabetic foot problems have been treated on the vascular surgery service. The treatment approach has emphasized aggressive local foot surgery and frequent use of revascularization to avoid amputation. A total of 212 urgent or emergent foot operations were performed on 138 limbs in 114 diabetic patients for indications of infection, gangrene, or infected neurotrophic ulcers. The average number of operations per limb was 1.5 (range one to six) and per patients was 1.9 (range one to nine). Ischemia was sufficiently severe to require concurrent lower extremity revascularization in 48 limbs in 43 patients. Follow-up ranged from 1 month to 11 years (mean 3 years). Ultimately 36 major lower extremity amputations were required in 33 patients at time intervals ranging from zero to 86 months (mean 7 months) after the initial operation on the affected limb. These data indicate that an aggressive program of surgical treatment of diabetic foot problems combined with liberal use of lower extremity revascularization resulted in long-term salvage of 73% of threatened limbs in these high-risk patients. These results form the basis for our recommendation that major lower extremity amputations be considered only as a last resort in diabetic patients with limbs threatened by foot infection or localized gangrene.