From July 1964 to July 1970, 193 major lower-extremity amputations were performed on 177 consecutive patients for ischemia by the Prosthetics Research Study team. Of these amputations, 101 were performed in diabetic patients; eighty-three in non-diabetic patients; and four in patients with Buerger's disease. The initial levels of amputation were above-the-knee in twenty-eight, below-the-knee in 157, Syme in two, and knee disarticulation in three. The final levels were above the knee in forty, knee disarticulation in three, below the knee in 145 (two bilateral) and Syme in two (one bilateral).
Selection of the level for amputation, the technique of below-the-knee amputation, the rigid dressing, immediate postsurgical prosthetic regimen, the procedure for weight-bearing and ambulation, and the method of follow-up are described.
The results in terms of rehabilitation of the patients to a functional status are analyzed. Only nine of the 132 below-the-knee and Syme amputees and eight of the thirty-one above-the-knee and knee-disarticulation amputees who were fitted with a definitive prosthesis failed to gain independence out of the home. Seventy-four of the eighty-one below-the-knee and Syme amputees, who were sixty years old or older, were fitted with a definitive prosthesis and gained full independence out of their homes.
Twelve below-the-knee amputations failed to heal and reamputation above the knee was required. Of these failures, seven could be attributed to incorrect selection of the level and five to inadequate postoperative management.
It is concluded that with strict adherence to the precepts outlined with respect to the selection of the level, surgical technique, and postsurgical management. consistently high rates of healing and rehabilitation can be achieved after below-the-knee amputation for vascular insufficiency.