222-OR: A Call for a New Limb Salvage Paradigm for Patients with Diabetes

Five-year mortality rates for patients with diabetes who undergo lower extremity amputation (LEA) have long been regarded as high and inevitable. Accepted five-year mortality rates exceed 50%. The aim of this study was to assess 5-year mortality after LEA performed with a multidisciplinary approach focused on function. We retrospectively enrolled all patients (n=312) with diabetes who underwent primary non-traumatic LEA at our institution from 2010-2013. Patients were stratified by LEA type: minor (toe, ray, TMA, Lisfranc, Chopart, Symes) or major (BKA, AKA). Surgical technique optimized biomechanics via tendon rebalancing with repurposing plantar skin for anterior coverage for minor LEA and myodesis of residual muscles with posterior myocutaneous flap closure for major LEA. Our multidisciplinary team, consisting of wound care, reconstructive, podiatric, vascular, and prosthetic specialists, ensures recovery and post-LEA function. Mortality was established via medical records and a commercial database then analyzed with Kaplan-Meier estimates. Five-year mortality was 31% (Figure); Charlson Comorbidity Index was 5.5±2.2. Five-year mortality was not significantly different for minor versus major LEA. In conclusion, we have demonstrated improved 5-year mortality after LEA with multidisciplinary care focused on functional outcomes. Successful “limb salvage” is evaluated by preservation of function instead of limb length.