Primary Partial Closure in Below-Knee Amputation for Diabetic Foot Disease: A Single-Arm Prospective Observational Study

Background: Below-knee amputation (BKA) in advanced diabetic foot disease is often complicated by stump wound problems. The best closure strategy remains unresolved, and outcome data for primary partial closure (PPC), in which a dependent segment is left open for drainage, are sparse. Objective: This study aims to describe wound-healing and short-term postoperative outcomes following primary partial closure in below-knee amputation for diabetic foot disease. Methods: This single-arm prospective observational study was conducted at Ibrahim Cardiac Hospital & Research Institute, Dhaka, from January 2023 to December 2025. Sixty-four consecutive adults with type 2 diabetes (HbA1c ≤10%) undergoing non-emergency BKA all received PPC. Co-primary outcomes were complete healing within 90 days and time to healing. Secondary outcomes included surgical site infection (SSI), revision, re-amputation, systemic complications, hospital stay, and 30-day mortality. Results: Mean age was 60.59 ± 10.42 years; 67.2% were male, and 92.2% were ASA III–IV. Two patients (3.1%) died within 30 days. Of 62 survivors at 90 days, 56 (90.3%) achieved complete healing, with a median time of 42 days (IQR 34–57). SSI occurred in 7.8%, stump revision in 7.8%, and above-knee re-amputation in 4.7%. At least one complication occurred in 18.8%. Mean hospital stay was 10.16 ± 4.83 days. Conclusion: In this high-risk cohort, about nine in ten survivors healed within 90 days, with few conversions to above-knee amputations. Lacking a comparator and with wide confidence intervals, the study cannot establish superiority over other closure methods; comparative studies are needed.