LONG-TERM PROGNOSIS AFTER HEALED AMPUTATION IN PATIENTS WITH DIABETES

In this prospective study, mortality, rehabilitation, and new amputati ons on the same or on the contralateral leg were studied in 189 patien ts with diabetes who had achieved healing of an index amputation. Nine ty-three patients had achieved healing after an index minor (below the ankle) and 96 after an index major (above the ankle) amputation, prec ipitated by a foot ulcer. The healing time was 29 weeks (range, 3-191 weeks) with a minor amputation and 8 weeks (range, 3-104 weeks) with a primary major amputation. The mortality 1, 3, and 5 years after the i ndex amputation was 15%, 38%, and 68%, respectively, and was higher in patients who had achieved healing after major amputation than in pati ents achieving healing after minor amputation. The rate of new amputat ions after 1, 3, and 5 years of observation was 14%, 30%, and 49%, res pectively. There was no difference among patients with an index minor and those with an index major amputation. The rate of new major amputa tions was 9%, 13%, and 23%, respectively, and,vas higher in patients w ith an index major amputation. Eighty-five percent of new amputations were precipitated by a foot ulcer. Patients living independently befor e the index amputation returned to living independently more often aft er a minor than a major amputation (93% versus 61%). One year after th e index amputation, 70% of patients who had achieved healing after hav ing a minor amputation and who could walk I km or more before amputati on had regained this walking capacity, compared with 19% of patients h aving a major amputation. Seventy percent of patients with an index tr anstibial amputation who could walk before amputation were fitted with a prosthesis, and 52% were using it regularly. Patients with diabetes who had an index major amputation had a higher mortality, an equal ra te of new amputation, and a lower rehabilitation potential than did pa tients who had an index minor amputation.