CLINICAL CHARACTERISTICS IN RELATION TO FINAL AMPUTATION LEVEL IN DIABETIC-PATIENTS WITH FOOT ULCERS - A PROSPECTIVE-STUDY OF HEALING BELOWOR ABOVE THE ANKLE IN 187 PATIENTS

The aim of this study was to describe the clinical characteristics in relation to final amputation level in diabetic patients with foot ulce rs. In a prospective series, 187 consecutively presenting patients wer e investigated. From admission until final outcome, the patients were treated by a multidisciplinary team both as in- and out-patients. All the patients had one or more signs of neuropathy and 171 had evidence of peripheral vascular disease. Healing with an amputation below the a nkle occurred in 74 patients, 88 patients healed with an amputation ab ove the ankle, and 25 patents died unhealed. Amputation above the ankl e was associated with high age, living in an institution, a limited wa lking capacity, cerebrovascular disease, congestive heart failure, and a low hemoglobin level. Amputation below the ankle was associated wit h diabetes diagnosis before 30 years of age and diabetes duration. In conclusion, older age, history of cerebrovascular disease and low hemo globin level are associated with above ankle amputation level in diabe tic patients with foot ulcers. However, level selection cannot be base d upon these factors only, since some patients at high age, with cereb rovascular disease or with a low hemoglobin value, healed with an ampu tation below the ankle. None of these factors per se should be taken a s a cause to choose a primary amputation above the ankle, unless amput ation is supported by the total clinical picture, including local char acteristics, such as type and localization of ulcer, and signs of peri pheral vascular disease. More attention should be paid to biological t han to chronological age.