Introduction
Diabetes is a leading cause of lower-limb complications, including foot ulcers, infections, and gangrene. When conservative management fails, surgical intervention is necessary. The two main surgical approaches are limb-salvage surgery (LSS)—including revascularisation, debridement, and reconstruction—and amputation. Choosing the optimal procedure is complex, with implications for survival, mobility, and quality of life.
Main Study Evidence
Attinger and Brown (2012) conducted a 20-year retrospective review of diabetic limb salvage versus amputation. They found that with a team-based approach, limb salvage yielded a 64% ambulation rate and 80% 2-year survival, whereas below-knee amputation resulted in a similar ambulation rate but only 52% 2-year survival. Patients with more severe rear-foot ulcers and osteomyelitis had progressively lower ambulation rates, highlighting the influence of comorbidities on outcomes. Importantly, those whose foot was saved had a higher chance of walking compared with amputees, emphasising that function and quality of life are central outcomes (Attinger & Brown, 2012).
Clinical Considerations
While limb salvage can improve survival and maintain mobility, it often requires multiple procedures, longer hospitalisation, and close follow-up. Amputation may provide a faster rehabilitation pathway in patients with extensive infection or poor perfusion, but is associated with higher mortality, prosthetic dependence, and reduced mobility. Patient selection should consider vascular status, infection severity, comorbidities, and personal activity goals.
Conclusion
Evidence from Attinger & Brown (2012) suggests that limb-salvage surgery can offer superior survival and functional outcomes for diabetic patients compared with amputation, provided a multidisciplinary approach is used. However, amputation remains a valid option when limb salvage is unlikely to succeed. Treatment decisions must be individualised, balancing survival, function, and quality of life.
References
- Attinger CE, Brown BJ. Amputation and ambulation in diabetic patients: function is the goal. Diabetes Metab Res Rev. 2012 Feb;28 Suppl 1:93-6. doi: https://doi.org/10.1002/dmrr.2236 PMID: 22271731.
- Northwest Extremity Specialists. (n.d.). Limb salvage: Reducing the need for amputation. Retrieved from https://nespecialists.com/foot-and-ankle-surgery/limb-salvage/
- BINASSS. (2025). Epidemiological review of diabetic foot complications in Costa Rica. Retrieved from https://www.binasss.sa.cr/ene25/44.pdf
Disclaimer: This blog is for informational purposes only and should not be considered medical advice. Please consult with your healthcare provider for any questions or concerns regarding your health. All surgical or invasive procedures involve potential risks. It is advisable to seek a second opinion from a suitably qualified healthcare professional before making any decisions.
