One hundred and seventy-eight lower extremity amputations performed on 103 diabetic patients were reviewed. Although the healing rate for the above-the-knee amputation was higher, the probability of prosthetic use and ambulation was greater with the mid-leg amputation, particularly if the patient required bilateral amputation. Late breakdown of the mid-leg stump, once healing had occurred, was not a significant problem. We feel that the proper amputation level is bestdetermined by the skin temperature and appearance at the proposed amputation site rather than rigid reliance on the presence of pulses, oscillometry, or arteriography and that every effort should be directed to retaining a functioning knee.

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