The syme amputation

Success in elderly diabetic patients with palpable ankle pulses

Hugh Francis, James R. Roberts, G. Patrick Clagett, Frank Gottschalk, Daniel F. Fisher

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

The Syme amputation is an old operation that has been used during this century primarily as a means of treating traumatic injuries to the forefoot in military patients. In 1984 we made a deliberate attempt to perform the operation in a highly selective group of dysvascular patients with forefoot necrosis who happened to have a palpable posterior tibial pulse. We reviewed the charts of 26 patients who underwent a one-stage (3 patients) or two-stage (23 patients) Syme amputation. The mean age was 60 years, (range 32 to 74 years). There were 17 insulin-dependent diabetic patients, and 3 diet-controlled diabetic patients. Twenty-two patients (85%) had a palpable posterior tibial pulse before surgery. Fourteen patients (54%) underwent a preliminary Ray (4) or transmetatarsal (10) amputation to rid the forefoot of an active infection. Overall, 20 patients (77%) had successful Syme amputations. Nineteen of 22 patients (85%) with a palpable posterior tibial pulse had a successful amputation in contrast to one out of four patients (25%) who did not have a palpable pulse before surgery (p = 0.04). The mean follow-up of all patients was 23 months. The durability of the operation was demonstrated in finding that only one patient in 20 initially successful Syme amputations required revision to the below-knee level. The two-stage Syme amputation can be a very gratifying operation with success rates aproaching 85%, even if offered to elderly diabetic patients. The single most important feature for success is to limit the operation to those patients with a palpable posterior tibial pulse before operation.

Original languageEnglish (US)
Pages (from-to)237-240
Number of pages4
JournalJournal of Vascular Surgery
Volume12
Issue number3
DOIs
StatePublished - 1990

Fingerprint

Amputation
Ankle
Diabetic Diet
Knee
Necrosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Francis, H., Roberts, J. R., Clagett, G. P., Gottschalk, F., & Fisher, D. F. (1990). The syme amputation: Success in elderly diabetic patients with palpable ankle pulses. Journal of Vascular Surgery, 12(3), 237-240. https://doi.org/10.1016/0741-5214(90)90142-W

The syme amputation : Success in elderly diabetic patients with palpable ankle pulses. / Francis, Hugh; Roberts, James R.; Clagett, G. Patrick; Gottschalk, Frank; Fisher, Daniel F.

In: Journal of Vascular Surgery, Vol. 12, No. 3, 1990, p. 237-240.

Research output: Contribution to journalArticle

Francis, H, Roberts, JR, Clagett, GP, Gottschalk, F & Fisher, DF 1990, 'The syme amputation: Success in elderly diabetic patients with palpable ankle pulses', Journal of Vascular Surgery, vol. 12, no. 3, pp. 237-240. https://doi.org/10.1016/0741-5214(90)90142-W
Francis, Hugh ; Roberts, James R. ; Clagett, G. Patrick ; Gottschalk, Frank ; Fisher, Daniel F. / The syme amputation : Success in elderly diabetic patients with palpable ankle pulses. In: Journal of Vascular Surgery. 1990 ; Vol. 12, No. 3. pp. 237-240.
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