Angiography-Guided Limb Salvage Planning in a Surgical Candidate With Gas Gangrene of the Foot

Gas gangrene is a fulminant soft-tissue infection that requires rapid intervention to prevent extensive tissue destruction and mortality. Diabetic patients with peripheral neuropathy often have delayed recognition of injuries and impaired wound healing, placing them at substantially higher risk of severe complications. This report presents a 60-year-old male patient with diabetes and peripheral neuropathy who developed gas gangrene of the right foot. Despite two initial debridements, concern remained for progressive infection necessitating limb amputation. An abdominal aortogram with run-off demonstrated preserved distal perfusion of the right lower extremity, allowing the surgical team to consider below-the-knee amputation (BKA) rather than above-the-knee amputation (AKA). BKA allows for improved prosthetic fitting and lower energy expenditure during ambulation, which is preferable to the outcomes typically seen with AKA. Ultimately, the patient chose to defer amputation and arranged for outpatient follow-up to revisit the decision at a later time. This case underscores the role of angiography in guiding amputation planning and highlights the need to balance clinical judgment with patient autonomy in limb salvage decisions.