Prevention of major amputations in the diabetic patient

Five of six major amputations of the lower extremity involve diabetic patients. It should be possible to reduce the number of major amputations by substituting reconstructive for destructive surgery, by radical local surgical debridement, by achieving healing of chronic foot lesions, by the early diagnosis of spread of infections from foot to leg, by limiting minor amputations, by improving the blood supply, and by providing a continuum of care by experienced personnel who supervise the foot status of the patient on an ongoing basis. In my experience, the application of these principles over the past seven years has precluded major amputation in the treatment of 48 diabetic patients with serious lower extremity lesions.