The decision to amputate

When a major amputation is being considered the following factors should be addressed by the multidisciplinary team:

• Social factors: some practitioners believe that patients who face many weeks or months of treatment should be offered a major amputation as a serious treatment option and that amputation can often be viewed very positively. Elliott Joslin felt that if life expectancy was very limited it could not be regarded as a success if the patient spent much of his remaining days in hospital to save his leg

• Emotional factors: many patients and their families react with horror to the idea of a major amputation. Depression after amputation is common

• Financial factors: diabetic foot patients may be regarded as 'expensive' patients in terms of:

Number of bed days occupied Consumption of expensive antibiotics Cosdy interventions. However, major amputation is not cheap and involves: Accumulated costs of rehabilitation Prosthetics service Loss of earnings Costs of special services

• Functional factors: in elderly, frail diabetic patients the functional results of amputation are usually poor: many patients do not walk again and never return to independent living.

There should be clear criteria for amputation as described above, and the decision should be made by a multidisciplinary team together with the patient and his family. Sometimes the decision is not an easy one.

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