Reasons for major amputation

Diabetic patients who present with extensive ulcers on their feet are sometimes offered early amputation as 'the one sure way of sorting out the problem permanently', on the basis that such an operation is likely to be inevitable at some time in the future. This approach may be useful for young, otherwise healthy, non-diabetic patients incapacitated by pain or a useless limb, whose other limb is normal. However, major amputation does not guarantee an ulcer-free existence for the diabetic patient, and nonhealing ulcer alone should not normally be an indication for major amputation.

Major amputation is usually carried out for the neuroischaemic foot and should be rare in the neuropathic foot. Major amputation in the neuroischaemic foot is necessary in the following circumstances:

• When overwhelming infection has destroyed the foot and threatens the patient's life

• When there is severe ischaemia with rest pain that cannot be controlled

• When extensive necrosis secondary to a major arterial occlusion has destroyed the foot.

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