The Journal of Bone and Joint Surgery, Vol 68, Issue 7 1061-1064, Copyright © 1986 by Journal of Bone and Joint Surgery, Inc
Amputations at the middle level of the foot. A retrospective and prospective review
M Pinzur, M Kaminsky, R Sage, R Cronin and H Osterman
Recent trends in amputation surgery favor amputation at the most distal
level to preserve the patient's ability to walk. This paper reports the
results of sixty-four amputations performed at the level of the middle of
the foot in fifty-eight patients. All were performed in patients with
peripheral vascular disease who had a diagnosis of either gangrene or
resistant, nonhealing ulcers. Forty-three patients (74 per cent) had
diabetes. Nutritional evaluation of the patient was used to improve the
potential for healing. In the initial forty-six patients, a retrospective
review of the serum albumin level, the blood total-lymphocyte count, and
the Doppler ischemic index was performed. A prospective study was performed
in the final twelve patients, in whom a minimum level in each of these
three factors was required before the distal amputation was done. The
healing rate for all sixty-four amputations was 81 per cent. When all three
factors were above the minimum level, the healing rate was increased to
92.2 per cent. When one or two of the factors was below the minimum level,
the rate of healing decreased to 38.5 per cent. Aggressive distal
amputation can be performed with a high rate of success when the factors
influencing the decision on the amputation level include non-invasive
vascular testing and nutritional evaluation.
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