Amputation in the context of infectious and ischemic foot and ankle diseases, including diabetic foot, Buerger's disease, arteriosclerosis obliterans, and frostbite, demands a reconstructive approach aimed at functional restoration rather than mere disease removal.Surgical success depends on meticulous debridement, tension-free closure, strategic determination of the amputation level based on vascular assessment, and staged management of concurrent infection.Proper tourniquet use, preservation of viable soft tissue, including plantar skin flaps, appropriate wound closure, and the judicious use of skin grafts and flap surgery are fundamental principles.Vascular evaluation, including Doppler ultrasonography and transcutaneous oxygen pressure measurement, guides the amputation plane.Optimizing the nutritional status and glycemic control is critical in the diabetic population.Beyond the surgical technique, the psychosocial burden on patients and caregivers demands a multidisciplinary approach incorporating psychological support and social services.Clear, documented informed consent that specifically addresses the intraoperative level change and re-amputation risk is an ethical obligation and an essential legal safeguard.A successful outcome requires balancing limb salvage with functional restoration while addressing the clinical, psychological, and legal complexities of these cases.
Shin et al. (Mon,) studied this question.