Major Amputations in Diabetics

Major amputations — below knee amputation (BKA), above knee amputation (AKA), and through knee amputation (TKA) are the most dreaded complications of all diabetics presenting with diabetic foot problems. These amputations lead to a reduction in quality of life and impose a huge emotional burden on both the amputee and his family. Besides causing much morbidity, there is also high mortality risk involved with these amputations. The risk of mortality is about 10% during amputation and increases to 30% within one year, 50% within three years and 70% within five years. It therefore leads to loss of life, an important fact that is not well recognised or appreciated by both health care professionals and patients. These amputations must therefore be avoided by good preventive measures such as annual foot screening, good management of diabetes by a team approach, and an efficient clinical pathway when prevention fails.

It is therefore essential that when major amputations are performed, they must be done by diabetic surgeons well versed with the problems of diabetic limbs, the vascularity of the limbs and potential for tissue and wound healing in diabetics. Amputations performed on diabetics require special techniques quite different from amputations performed for trauma if the stump is to heal well. This chapter describes the special techniques for performing such major amputations in diabetes in detail.