Risk factors in local surgical procedures for diabetic gangrene.

One hundred and seventy-two diabetic patients undergoing local operations of the foot distal to the ankle joint were reviewed to explore the preoperative prognostic indicators of operative failure. Severity of infection, as measured by preoperative temperature and white blood count, correlated with that of failure. Subcutaneous gas, as seen roentgenographically, was associated with failure in five of six patients. No particular operation or type of wound and no general or specific medical or laboratory parameter correlated with failure. In the four and one-half years of the study, an improved operative success rate could only be correlated with improved preoperative management of infection, as reflected in a declining yearly preoperative white blood count and temperature. Delay of the operation until maximum medical control of the infection has occurred should improve the initial success rate in these patients.