Salvage of the diabetic foot - An interdisciplinary challenge

In 35 patients with diabetic gangrene, amputation above the ankle (n=18) or below the ankle (n=17) was planned by nonspecialised general surgical departments or practicing surgeons. Prior to the operation, these patients presented to a specialised diabetic foot clinic; their clinical courses were analysed retrospectively. Results: in 14 cases, peripheral arterial occlusive disease (PAOD) stage IV was the underlying cause, which was treated by bypass-surgery in 10 cases and by angioplasty in 1 case. In 2 cases, bypass-operation was impossible due to anatomic conditions, and in 1 case it failed (all 3 cases were amputated below knee). In 21 patients, neuropathic infection was the underlying cause (without PAOD), which was unrecognized. In 13/21 cases osteomyelitis, and in 7/21 cases Charcot-foot was present. Treatment consisted of drainage, pressure relief, antibiotics, and minor amputations (3 toes, 3 mid-foot). Conclusion: in our retrospective analysis, 83% of major amputations that had been considered by non-specialised surgeons, could be prevented by a combined medical and vascular surgical approach. 79% of the minor amputations that had been considered, proved to be unnecessary. Thus, salvage of the gangreneous diabetic foot is possible in the majority of cases, provided suitable vascular surgery and infection containment. The traditional high amputation rate in diabetic patients seems to be unfounded.