The decision to perform an amputation is based on a complex mix of

medical and social/functional considerations. In the past, most have

measured quality of care based on numbers of amputations performed in

a set amount of time. More recently, some have advocated the use of

simple potential quality measures that can be rapidly assessed without

the necessity of population-based incidence figures. One such measure

is the the "high to low amputation". In a recent study, our guest,

James Wrobel, Associate Professor and Director of Outcomes Research at

Scholl's Center for Lower Extremity Ambulatory Research at Rosalind

Franklin University of Medicine and Science, reported a nationwide

ratio of 1.35-- but with large variations between individual centers.

Perhaps these variations are an opportunity for intervention and the

beginning of a discussion? Also discussed is another proposed measure

of quality, William Jeffcoate's "Ulcer Free Days" concept.