The Syme amputation: success in elderly diabetic patients with palpable ankle pulses

The Syme amputation of the foot at ankle level was used extensively during World War II to treat traumatic injuries of the forefoot. A four-year review of the authors' experience using this procedure is presented. The procedure was performed to treat 26 patients with infection and necrosis (localized tissue death) of the forefoot. The average age of the patients was 61, all were men, and all admitted to cigarette smoking. Twenty patients had diabetes; 17 were insulin-dependent. Palpable ankle pulses were present in 22 patients (85 percent). Prior to Syme amputation, 14 had preliminary surgery to eliminate active infection from the forefoot. Syme amputation was successful in 20 of 26 patients (77 percent). The success rate for patients who had palpable ankle pulses was 86 percent (19 of 22 patients), compared with a rate of 25 percent (1 of 4) for patients who did not have palpable ankle pulses prior to surgery. The patients were followed for an average of 23 months. Of the 20 successful operative procedures, only one patient eventually required further amputation; a below the knee amputation was performed two years after Syme amputation, because of stump infection. It is concluded that the Syme amputation can be successfully used even in elderly diabetic patients; however, it is important that the operation be limited to patients who have palpable ankle pulses at the time of surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)