SYME ANKLE DISARTICULATION IN PERIPHERAL VASCULAR-DISEASE AND DIABETIC FOOT INFECTION - THE ONE-STAGE VERSUS 2-STAGE PROCEDURE

A prospective randomized trial compared performing a Syme ankle disart iculation using a one-stage versus Wagner's two-stage technique. Surge ry was performed at two University Medical Centers where patients unde rwent amputation surgery for gangrene or nonsalvageable diabetic foot infection, Those undergoing surgery subsequent to trauma or congenital anomaly were eliminated. Initially, 21 patients were randomized into one-stage and two-stage surgery. The randomization was stopped for eth ical reasons when the results of both procedures appeared to be simila r. The next 22 consecutive patients underwent 23 Syme ankle disarticul ations in one-stage surgery. Selection of amputation level was based o n clinical examination, transcutaneous oximetry as a measure of vascul ar inflow, serum albumin as a measure of tissue nutrition, and total l ymphocyte count as a measure of immunocompetence. As a total group, 31 of 44 amputations progressed to amputation wound healing and prosthet ic limb fitting. In the randomized group, 9 of 13 one-stage and 5 of 8 two-stage surgeries healed. In the subsequent consecutive group, 17 o f 23 healed. In all, 26 of 36 one-stage and 5 of 8 two-stage surgeries healed successfully. We concluded from this study that Syme ankle dis articulation may be performed as safely in one stage as in two stages in properly selected patients and, therefore, recommend the one-stage Syme ankle disarticulation in those patients suitable for this level a mputation.