THE MANAGEMENT of gangrene and infection of the lower extremities associated with arteriosclerosis and diabetes has made important strides since the advent of antibiotics. With the control of most foot infections, a more conservative treatment of the necrotic lesions per se has become possible. Whereas before the use of antibiotics major amputations were frequently unavoidable, since their availability local foot surgery, in selected cases, has become feasible and safe and has often resulted in salvage of the limb.
Good results following transmetatarsal amputation for ischemic gangrene and infection in 75 patients with diabetes were first reported by McKittrick in 1946.1 Subsequently, Furste and Herrmann in 1948,2 McKittrick and his associates in 1949,3 Warren and his associates in 1952,4 and others * further emphasized the value of this conservative surgical procedure.
With the introduction of the transmetatarsal amputation into the surgical armamentarium, there was good reason to believe