Syme amputation in patients with severe diabetes mellitus

Surgical results and functional outcome of 52 patients treated with Syme amputations for forefoot gangrene between 1986 and 1988 were retrospectively reviewed with reference to the predictive value of posterior tibial artery Doppler examination. Wound healing was correlated with the preoperative status of the posterior tibial artery. Functional outcome was assessed by the ability to wear a prosthesis, ambulatory capabilities, episodes of ulceration, and revision surgery. Follow-up averaged 27 months. Twenty-nine patients had a posterior tibial artery with either a triphasic waveform (N = 23) or a normal pulse (6). Twenty-six (90%) of these achieved a healed wound suitable for prosthetic wear. Twenty-three patients had monophasic flow in the posterior tibial artery. Thirteen (57%) of these achieved a healed wound. Ninety percent of the patients who achieved healed wounds were fit with a prosthesis. Functional level of ambulation was assessed in 20 patients. Eighteen were community level ambulators, 11 could walk three or more blocks, and 16 could climb stairs. Eighteen wore their prosthesis all day. These findings indicate that posterior tibial artery Doppler examination is predictive of healing in the Syme amputation performed on diabetics. Furthermore, diabetics can attain a functional level of ambulation with a Syme amputation.