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Albumin of 3.4
3%
56/1607
Active osteomyelitis
7%
105/1607
ABI of 0.4 for the posterior tibial artery
77%
1242/1607
Transcutaneous oxygen pressure of 45
6%
93/1607
Peripheral neuropathy
106/1607
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A Syme amputation (ankle disarticulation) is a function-preserving amputation option that allows for terminal weight bearing, however strict criteria must be met for a patient to undergo successful Syme amputation. An ankle-brachial index (ABI) less than 0.5 for the posterior tibial artery in a patient with diabetes would be a contraindication for this procedure as success is dependent on the vascular supply of posterior tibial artery to the plantar flap and heel pad. Pinzur et al retrospectively reviewed their results when performing a single-stage Syme ankle disarticulation in patients with diabetes either for peripheral neuropathy or infection. Patients with ABIs less than 0.5 for the posterior tibial artery had significantly decreased healing rates and smokers had a three-fold increased risk of postoperative infection. Incorrect Answers: Answer 1: Albumin of 3.4 indicates adequate preoperative nutrition. Albumin of 2.0 or less would be concerning for increased wound healing risk. Answer 2: Osteomyelitis was the indication for amputation in a number of diabetic patients in the referenced study, and should not preclude Syme amputation unless the hindfoot and/or distal tibia is involved Answer 4: Transcutaneous 02 pressure of 45 signifies adequate oxygenation and vascularity. Less than 30 is generally considered a cutoff for adequate vascularity. Answer 5: Peripheral neuropathy with recurrent ulceration was an indication for amputation in the referenced study.
3.8
(27)
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