LOCAL SIGNS AND SYMPTOMS IN RELATION TO FINAL AMPUTATION LEVEL IN DIABETIC-PATIENTS - A PROSPECTIVE-STUDY OF 187 PATIENTS WITH FOOT ULCERS

Local signs and symptoms were evaluated in 187 consecutively presentin g diabetic patients undergoing amputation for foot ulcers. From admiss ion until final outcome the patients were treated by the same multidis ciplinary team both as in- and outpatients. At the time of amputation, the types of lesions were superficial/deep ulcer (n 17), ulcer with d eep infection, but without gangrene (n 40), and gangrene with or witho ut infection (n 130). Healing after a minor amputation (below the ankl e) occurred in 74 patients, while 88 patients healed after a major amp utation (above the ankle), and 25 patients died before healing had occ urred. Deep infection and presence of popliteal or pedal pulses were a ssociated with healing after minor amputation and so were ulcers on th e small toes, metatarsal head area and midfoot. Pain, progressive gang rene, intermittent claudication, and decubital and multiple ulcers wer e related to healing after major amputation. In a logistic regression analysis, pain, progressive gangrene and intermittent claudication rem ained. However, none of these factors excluded healing of a minor ampu tation and thus selection of amputation level in diabetic patients wit h foot ulcers cannot be based upon these factors exclusively.