Abstract

ABSTRACTFrom 1977 to 1984, 87 above- and below-knee amputations were done on 77 patients for ischemic ulcerations and gangrene of the lower extremities. The overall three-month mortality was 14% and was mainly related to generalized atherosclerosis. Patients having infections with gas formations were more likely to be diabetic (80% vs 15%, P <.01), have clinical sepsis and a higher preoperative WBC (19,000 vs 12,600/cu mm, P <.01), and have a higher mortality (40% vs 12%, P <.05) than those with infections due to non-gas-forming organisms. Mixed bacterial flora were cultured from most wounds. We conclude that (1) infections with gas formation may be due to either clostridial or nonclostridial organisms, (2)‘ mortality is higher if gas accumulates and if the patient is diabetic, (3) gas is more likely to accumulate in infected extremities of diabetic patients, and (4) the combination of gas formation and diabetes is highly lethal.