Diabetic infective gangrene of lower extremity: one stage versus two stage amputation

ABSTRACT

Primary wound closure with reduced rate of infection could be assured by the two stage amputation technique although it entails an additional operation. To evaluate this issue 28 patients with diabetic wet gangrene of the foot were allocated to have either a one stage amputation [group A, 13 patients] or a two stage amputation [group B, 15 patients]. All patients had an intraoperative cultures from the foot and deep muscles to determine the presence of bacteria at the site of initial amputation. In group A definitive Syme, below or above-knee amputation were utilized while in group B we started with Ray, transmetatarsal or open ankle amputation to be followed by definitive transmetatarsal, closed Syme, or below knee amputation. While Six patients in group A had wound complications none of group B patients had such complications in the definitive amputation wounds. The staged amputations showed an excellent durability and none of the patients required a revision to a higher level, while in group A three patients required such a revision to a higher level. None of the group A patients had their ankle joint preserved while none of group B patients lost their knee joint. The two stage amputation can be a very gratifying technique that could end up with a more conservative amputation even if offered to elderly diabetic patients