Open Or Closed? Searching For Evidence-Based Guidance On Amputations

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Here is an example of a two-stage amputation that is now ready for debulking and delayed primary closure.
The vascular demands needed to heal a hallux amputation in this patient were underestimated. Gangrene in the forefoot led to a proximal amputation.
By Kathleen Satterfield, DPM

1. Fisher DF Jr, Clagett GP, Fry RE, Humble TH, Fry WJ.One-stage versus two-stage amputation for wet gangrene of the lower extremity: a randomized study. J Vasc Surg. 1988 Oct;8(4):428-33.
2. Pinzur MS, Smith D, Osterman H. .Syme ankle disarticulation in peripheral vascular disease and diabetic foot infection: the one-stage versus two-stage procedure. Foot Ankle Int. 1995 Mar;16(3):124-7.
3. Scher KS, Steele FJ. The septic foot in patients with diabetes. Surgery. 1988 Oct;104(4):661-6.
4. Rumenapf G. Borderline amputations in diabetics--open questions and critical evaluation. Zentralbl Chir. 2003 Sep;128(9):726-33.
5. Ziran BH, Rao N, Hall RA. A Dedicated Team Approach Enhances Outcomes of Osteomyelitis Treatment Clinical Orthopaedics and Related Research, Number 414, pg. 31-36. Lippincott Williams and Wilkins, Inc.

Additional Reference
6. Kumagi SG, Mahoney CR, Fitzgibbons TC, McMullen ST, Connolly TL, Henkel L. Treatment of diabetic (neuropathic) foot ulcers with two-stage debridement and closure. Foot Ankle Int. 1998 Sep;19(9):649.

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