During the past eight years, we performed 312 lower-extremity amputations for ischemia. Amputation requiring no prosthesis was achieved in 31% of patients, knee joint preservation in 72%, and overall primary amputation healing in 75%. Amputation mortality was 6%. The use of prior arterial reconstruction, careful wound care, and willingness to accept nonhealing of trial amputations were important factors in obtaining the most distal possible healed amputation. An accurate evaluation of the impact of new methods of selecting amputation level and evaluating amputation results can only be achieved by a report of the total institutional amputation experience, not by reports of a single type of amputation.