The number of major amputations above or below the knee has decreased by more than 33 per cent in seven years.

These went down from 133 amputations in 2003 to 89 in 2010, health minister Joe Cassar said this morning.

He was addressing a press conference at Mater Dei Hospital where the press could watch an artery bypass operation on a leg.

The surgeon performing the operation, Prof. Kevin Cassar, explained that major amputation has a very high mortality rate so reducing the number of these operations increased patients' mortality.

It is estimated that 10 to 20 per cent of people who have an amputation do not survive beyond 30 days and only five per cent managed to become completely independent.

Patients who had these operations required a long hospital stay, usually of around 30 days.

Dr Cassar explained that the decrease in operations was mainly due to the significant increase in lower limb bypass surgery. This increased four-fold in the past three years.

The reduction is due to the fact that more cases are picked up earlier – around 90 per cent of amputations are caused by diabetes which creates a lack of circulation in the lower limbs – when only the toes or the foot is affected.

By improving the blood supply or performing a minor amputation such as on the toe, the problem is detected earlier and major amputation is avoided. Most of these changes have come about following investment in resources both material and financial.

The department of health recently employed two consultant radiologists who performed balloon angioplasties to improve the blood supplies to the limbs and a consultant vascular surgeon who performs bypass procedures to improve the blood supply to the legs.

The government also invested in equipment such as a vascular ultrasound scanner, a CT scanner and special equipment that measures the blood flow to the foot and to the toes.

A multi-disciplinary diabetic foot clinic was also set up to help identify or treat patients at risk of limb loss.