Lower limb amputation for diabetic foot

We amputated 35 limbs of 27 patients with diabetic foot from March 1988 to March 1998. The mean age of the patients at the time of operation was 67 ye ars, and the mean follow-up period was 27 months. Thirteen patients died in the period from 1 day to 39 months after the operation. All patients suffe ring from diabetic foot were referred to our department for surgical proced ures after failure of conservative treatment conducted elsewhere. Their fee t were classified into grade 2-3 in 18 limbs, grade 4-5 in 11 limbs, and ga ngrene of the lower leg and entire foot in 2 limbs, as classified by the Wa gner system. Two patients had cellulitis of the foot and two other limbs ha d infectious gonarthritis. All patients had type 2 diabetes with poor blood sugar control, and 90% were treated by insulin. All patients suffered from diabetic neuropathy. Half of the patients were put on hemodialysis because of diabetic nephropathy. More than 60% of the patients suffered from arter iosclerosis obliterans. The amputation level of the limb was determined by skin thermography, but the patient's will was critical. The initial amputat ion levels were: debridement and synovectomy in 4 limbs, toe and digital ra y in 15 limbs, transmetatarsal in 3 limbs, transtibial in 9 limbs, transfem oral amputations in 4 limbs. Upper level reamputation was conducted on 15 l imbs. Logistic regression analysis revealed that lower temperature of the a mputation site, being female, and being elderly were significant risk facto rs in reamputation. Skin thermography was one of the effective determinants of amputation level, in order to avoid reamputation.