THE MANAGEMENT of gangrene of a toe or toes in patients with obliterative arterial disease, with or without diabetes mellitus, has gradually changed as a better understanding of the factors which are responsible for the spread of gangrene proximally in an affected foot has been acquired. The old axiom, "a gangrenous toe in a diabetic patient is always an indication for a supracondylar amputation," is no longer tenable. A natural, weight-bearing extremity can be obtained by a transmetatarsal amputation in many patients if proper precautions are exercised in the selection of cases and the execution of the operation.
We have employed this type of conservative amputation at the Cincinnati General Hospital since 1934, and we wish to present the facts which we believe are important in the selection of cases and the technical aspects of the operation which have given our best results.
In 1946, McKittrick1 reported that between