TECHNIQUESyme Ankle Disarticulation in Diabetic Dysvascular Disease and TraumaPinzur, Michael S MDAuthor Information Department of Orthopaedic Surgery & Rehabilitation Loyola University Medical Center Maywood, Illinois Address correspondence and reprint requests to Michael S. Pinzur, MD, Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153. E-mail: [email protected]. Techniques in Foot & Ankle Surgery: March 2004 - Volume 3 - Issue 1 - p 15-22 Buy Abstract Syme ankle disarticulation is a disability and function-sparing amputation level that has been used sparingly in patients with diabetes due to the perceived high risk for wound failure, wound infection, and migration of the heel pad. This “Techniques” article discusses the indications and surgical technique for performing Syme ankle disarticulation for diabetic dysvascular disease, nonsalvageable trauma, and congenital deformity. Amputation level selection is based on clinical examination and threshold wound healing parameters of vascular inflow (ankle-brachial index of 0.5 or transcutaneous oxygen tension of between 20–30 mm Hg), nutrition (serum albumin of 2.5 g/dL), and immunocompetence (total lymphocyte count of 1500). Wound healing rates of greater than 80% can be expected, even in the diabetic, neuropathic dysvascular population. Prevention of the late complication of heel pad migration has been addressed by stabilizing the heel pad to the distal tibia via nonabsorbable sutures. The results of this series support the use of the Syme ankle disarticulation in diabetic patients with infection or gangrene of the foot. Patients appear to survive longer and remain more ambulatory than similar patients undergoing transtibial amputation. Guidelines for wound healing parameters in the diabetic dysvascular foot have been readdressed. © 2004 Lippincott Williams & Wilkins, Inc.