One-stage versus two-stage [1mamputation [m for wet gangrene of the lower

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extremity: a randomized study. Fisher-D-F-Jr. Clagett-G-P. Fry-R-E. Humble-T-H. Fry-W-J. J-Vasc-Surg. 1988 Oct. 8(4). P 428-33. Although the two-stage [1mamputation [m technique entails an additional operation, several authors have advocated this approach to deal with wet gangrene because it allows primary wound closure with a reduced chance of wound infection. To examine this issue, 47 patients with necrotizing wet gangrene of the foot were randomized prospectively to receive either a one-stage [1mamputation [m (definitive below- or above-knee [1mamputation [m with delayed secondary skin closure in 3 to 5 days) or a two-stage [1mamputation [m (open ankle guillotine [1mamputation [m followed by definitive, closed below- or above-knee [1mamputation [m). Antibiotic coverage was standardized with clindamycin and gentamicin used in all patients. Preoperative blood cultures and intraoperative foot cultures were obtained, as well as cultures from the deep muscle and lymphatic area along the saphenous vein to determine the presence of bacteria at the level of initial [1mamputation. [m Twenty-four patients (11 diabetic and 13 nondiabetic) were randomized to the one-stage procedure. Twenty-three patients (14 diabetic and nine nondiabetic) were randomized to the two-stage procedure. Five of 24 patients in the one-stage group (21%) had positive muscle cultures vs 10 of 23 patients in the two-stage group (43%). Two of 24 patients in the one-stage group (8%) had positive lymphatic cultures vs 7 of 23 patients in the two-stage group (30%). Five of 24 patients in the one-stage group (21%) had wound complications attributable to the [1mamputation [m technique vs none of 23 patients in the two-stage group (p = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS) Author-abstract.