Abstract
The treatment of critical limb ischemia (CLI) in diabetic patients is challenging, and there has been no established surgical strategy for a specific level of amputation. Two types of CLI, one without infection and the other with infection, are categorized as type II and type IV, respectively, under the Kobe classification [1]. The efficacy of MRI in diagnosing diabetic foot osteomyelitis has been demonstrated in our previous studies2,3): in neuropathic ulcers (types I, III), diabetic foot osteomyelitis can be reliably distinguished from reactive bone marrow edema in every detail, even in the presence of severe soft tissue infection. MRI is not useful in ischemic ulcers (types II, IV), however, because of insufficient interstitial fluid. In the present study, based on the histopathological differences found between ulcers type II and IV we present a strategy for the surgical treatment of CLI.
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