Dillon R S
Ann Surg. 1986 Dec;204(6):643-9. doi: 10.1097/00000658-198612000-00005.
Thirty-four legs at risk of amputation due to peripheral arterial insufficiency associated with ischemic necrosis, soft tissue infections, osteomyelitis, and variable degrees of peripheral neuropathy were reported in 28 diabetic patients. Amputation had been considered in 27 legs for which standard therapies had failed for the current illness and in two legs in which standard therapy had failed for previous illnesses. Local therapy was the initial form of therapy for five legs in which standard therapy appeared likely to fail. Infection was controlled in all patients with the use of local antibiotics and compression boot therapy. Early leg amputation was avoided in all but one patient. Late leg amputation occurred in two patients who were lost to follow-up care. Osteomyelitis, ischemic necrosis, and advanced soft tissue infection were shown not to be clear-cut indications for amputation in the ischemic diabetic foot.
28例糖尿病患者报告了34条因外周动脉供血不足伴有缺血性坏死、软组织感染、骨髓炎及不同程度外周神经病变而有截肢风险的肢体。27条肢体因当前疾病的标准治疗失败而考虑截肢，2条肢体因既往疾病的标准治疗失败而考虑截肢。对于5条标准治疗可能失败的肢体，局部治疗是初始治疗方式。使用局部抗生素和加压靴疗法后，所有患者的感染均得到控制。除1例患者外，所有患者均避免了早期截肢。2例失访患者发生了晚期截肢。缺血性糖尿病足中，骨髓炎、缺血性坏死及严重软组织感染并非截肢的确切指征。
