Outcome of midfoot amputations in diabetic gangrene

Ann Vasc Surg. 2011 Aug;25(6):778-82. doi: 10.1016/j.avsg.2010.11.013. Epub 2011 Apr 21.


Background: Persistent high incidence of limb loss resulting from advanced foot gangrene in patients with diabetes prompted an aggressive foot salvage surgery as a final attempt before below-the-knee amputation (BKA). The aim of this study was to evaluate the role of transtarsal amputations in achieving limb salvage at our vascular surgery unit, King Fahd Hospital of the University, Saudi Arabia.

Methods: A prospective study was performed on all patients with diabetes who were admitted to the vascular surgery unit, and underwent transtarsal amputation between November 2005 and October 2010. Patients who had their forefoot removed at the tarsometatarsal level (Lisfranc amputation) or at the midtarsal joint (Chopart amputation) were included in the study. Patient factors, operative complications, operative mortality, wound healing, limb salvage, functional status, and survival rates were evaluated.

Results: Over the past 4 years, 32 patients with diabetes were included in this study. Of these, 24 had Lisfranc and 8 had Chopart amputations for advanced gangrene of the foot. A total of 28 patients had evidence of arterial occlusive disease. In all, 24 patients had concomitant revascularization (bypass grafting or percutaneous transluminal angioplasty). Two patients died in the perioperative period (operative mortality: 6%). The stump did not heal in 8 patients (27%) and BKAs had to be performed. Four BKAs and 2 above-the-knee amputations were required 3-28 months later. Functional ambulation at 6 months was achieved in 20 (67%) of 30 patients.

Conclusion: Aggressive attempts at foot salvage are justified in patients with diabetes with advanced foot gangrene after assuring adequate arterial perfusion. Transtarsal amputations salvaged about two-thirds of the limbs studied.

MeSH terms

  • Aged
  • Amputation, Surgical* / adverse effects
  • Amputation, Surgical* / mortality
  • Diabetic Foot / diagnostic imaging
  • Diabetic Foot / mortality
  • Diabetic Foot / pathology
  • Diabetic Foot / surgery*
  • Female
  • Gangrene
  • Hospitals, University
  • Humans
  • Limb Salvage
  • Male
  • Middle Aged
  • Prospective Studies
  • Recovery of Function
  • Saudi Arabia
  • Survival Rate
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Wound Healing