The influence of sepsis and ischemia on the natural history of the diabetic foot.

One hundred seventeen diabetic patients with lesions involving 174 extremities were reviewed to evaluate the natural history of the problem and specifically those factors that influence its course both acutely and chronically. The extremities of diabetic patients with foot lesions can be categorized based on severity of infection and presence of ischemia. Half of these patients developed lesions in the contralateral extremity either concurrently (synchronous) (7%) or later (metachronous) (43%). Major amputation was required in 59 of the 174 extremities evaluated (34%). In patients with metachronous lesions, unilateral amputations were required in 28 per cent of patients and bilateral amputations in 26 per cent. Limb salvage by revascularization required 1.4 operations per extremity, carried 2 per cent operative mortality and was successful in 66 per cent. Although 24 per cent of these patients died within 5 years of the initial presentation of their foot lesions, these data suggest that limb salvage attempts are reasonably successful and relatively safe. The combination of extremity sepsis and ischemia in the diabetic adversely effects the survival of both the extremity and the patient.