Effect of Vascular Occlusion on Amputation Level in Diabetic Foot

Objectives: We aimed to evaluate the effect of vascular occlusion on debridement and/or amputation levels in diabetic foot patients with regulated blood glucose levels and without deep tissue infection. Patients and Methods: The study included 31 patients (19 males, 12 females; mean age 65 years; range 52 to 81 years) followed up between 2002 and 2005. Mean follow-up was 25 months (18-59). Mean hospitalization time was 22 days (3-77). Thirty patients were discharged in good condition and one patient died. Results: All included cases had regulated blood glucose levels. A. dorsalis pedis and a. tibialis posterior were found totally occluded on Doppler ultrasonography. Despite occlusion, amputation levels were adjacent to necrotic areas. Eighteen patients had metatarsophalengeal joint disarticulation, 11 had transmetatarsal amputation, two had Syme amputation. Twenty-four patients (77%) were discharged without complications. During follow-up, six patients (19%) had new necrotic areas postoperatively, and underwent below-knee amputation. One case (4%) who had Syme amputation died after operation due to cardiac problems. Conclusion: We observed that instead of high levels of amputations which vascular surgeons suggest in diabetic food patients with vascular occlusion, tissue protective surgery is more appropriate.