The importance of limb preservation in the diabetic population

Karen Kim Evans, Christopher E. Attinger, Ali Al-Attar, Christopher Salgado, Carrie K. Chu, Samir Mardini, Richard Neville

Research output: Contribution to journalArticlepeer-review

85 Scopus citations


Objective: Limb salvage in the diabetic population is complex, controversial, costly and variable throughout the world. Within the diabetic population, the indications and morbidity surrounding major leg amputation have not been well defined. Research design and methods: A retrospective study of the Georgetown Limb Salvage Registry was conducted to determine outcomes in diabetic patients undergoing proximal forefoot/midfoot (PF/M) amputations and to help define the indications for major leg amputation in ambulatory diabetic patients. Results: Of the 937 ambulatory diabetic patients identified during this time period, 808 who presented with superficial ulcers or distal forefoot disease and who did not go on to PF/M or higher amputation were eliminated. Records of 88 patients (92 limbs) in the PF/M amputation group and 25 patients in the below the knee amputation (BKA) group were reviewed (no above knee amputations were performed). At 2 years in the PF/M amputation group, 80% (70/88) of patients were still alive, 73% (68/92) of the limbs remained intact, and 64% of patients (56/88) were ambulatory. In contrast, in the BKA population at 2 years, 52% (13/25) of patients were deceased and 64% (16/25) were ambulating with a prosthetic limb (or had been ambulating at the time of death). The only statistically significant difference between these two groups was the presence of Charcot collapse and rear-foot disease in the BKA group. Conclusion: Aggressive efforts at salvage with PF/M amputation procedures should be entertained prior to higher level amputations due to the increased morbidity and mortality evidenced.

Original languageEnglish (US)
Pages (from-to)227-231
Number of pages5
JournalJournal of Diabetes and Its Complications
Issue number4
StatePublished - Jul 1 2011
Externally publishedYes


  • Below the knee amputation
  • Chopart amputation
  • Limb salvage
  • Lisfranc amputation
  • Transmetatarsal amputation

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine


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