Controversies in Limb Salvage in Patients With Diabetes Mellitus

Diabetic foot ulcers are the most feared complications among patients with diabetes mellitus because these are frequently a harbinger to major lower extremity amputation after failed attempts at treatment or limb salvage. Though most of these ulcers go on to heal, there is a sizeable proportion that goes on to develop gangrene, deep infections, osteomyelitis, and unstable deformities. These cohorts of patients often require repeated, costly, and controversial attempts at limb salvage surgery. Considering the growing cost of care of these patients worldwide, controversies abound in the literature regarding the best approach for limb salvage that will provide the best possible outcomes. There are no clear guidelines regarding what limbs with diabetic ulcers to salvage and those that require immediate major amputation in the orthopedic literature. However, many reports have shown that aggressive efforts at salvage with partial foot amputations should be entertained before higher-level amputations because of the increased morbidity and mortality associated with major amputation. Level of Evidence: Level IV.