Abstract
Patients with critical limb ischemia（CLI）who undergo transmetatarsal amputation for gangrene of Rutherford VI to preserve the heels sometimes require a subsequent major amputation due to poor wound healing. These patients require additional long-term treatments, resulting in poor muscular recovery and lower activities of daily living（ADL）after discharge. On the other hand, a subset of patients who undergo below-the-knee amputation as the initial procedure are able to recover quickly with a prosthetic leg that helps with ADL. Thus, it is challenging to select the most appropriate treatment strategy. In order to identify indicators that may help select an appropriate treatment strategy, we reviewed cases of patients who did and did not require major amputation at our institution. A total of 31 patients with CLI（37 critically ischemic legs）were included in the study. Our findings demonstrated that patients who: 1）were unable to walk, 2）had hypoplastic left heart syndrome, and 3）had high white blood cell counts and C-reactive protein levels were significantly more likely to require major amputation.
