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

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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 - Sep 1990

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ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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