Amputation in the diabetic: ten years experience in a district general hospital

Over a period of 10 years, 149 amputations were performed for lower limb ischaemia in 119 diabetic patients. Thirty patients required amputation of the second limb. Ninety per cent of the patients were over the age of 60 years. Sixty four ischaemic limbs were treated by primary local amputation or debridement--29 healed successfully, 30 proceeded to a higher amputation. The incidence of multiple local operations was high. A below knee amputation was performed in 56 limbs--7 failed to heal and required a more proximal amputation. Seventy five patients in the series have died; 58 of these survived less than 3 years from their first amputation. The hospital stay for all patients was long; for an unsuccessful local amputation the average stay was 109 days. Conservative management with the Scotchcast boot has been shown to be satisfactory. This must be compared with the significant costs to the patient of early operative intervention.