Because of the mortality and risk of contra-lateral limb loss with above knee and below knee amputations, the role of trans-foot amputations is critical in limb salvage. For these amputations to be successful, they have to be well designed, bio-mechanically stable and, when healed, have to be adequately fitted by a pedorthetist. Frequently, textbook amputations cannot be performed because of the existing wound and infection. The patient then faces an immediate below knee or above knee amputation. We eschewed the traditional amputation templates and applied wound healing and soft tissue reconstructive techniques to salvage these limbs. In the process we always tried to maximize bone length and then apply assorted soft tissue techniques for coverage. We then evaluated our experience to see how effective this approach was. We reviewed the Georgetown limb salvage registry to identify all patients from 1992 to 2000 who underwent modified trans-foot amputations (trans-metatarsal, Chopart’s, or Lisfranc’s amputation). Trans-foot amputations performed on 128 limbs of 116 patients from 1992 to 2000. Success was measured by how long the patient was able to use the partially amputated limb and failure by when it progressed to a below knee amputation. Diabetes and/or dialysis dependant renal failure were present in 81 of 116 (70%) and 29 of 116 (25%), respectively. Peripheral vascular disease (PVD) was present in 65 (56%) of all patients. The wound presentations were: frank gangrene/osteomyelitis (70%), ulcer (15%), trauma (10%), and unknown (5%). Operatively, aggressive serial debridements were performed in conjunction with modern wound healing techniques and revascularization until a clean, granulating, well-vascularized wound was achieved. The most distal amputation was then performed that the remaining soft tissue envelope allowed. Skin graft, local and pedicled flaps were used where necessary. Tendon rebalancing was also performed. Overall wound closure and long term limb preservation were achieved in 114 patients (90%) while 14 patients went on to eventual below knee amputations {9/93 transmetatarsal amputation underwent a BKA 9 months after initial amputation, 1/19 Lisfranc amputations at 3 years, and 4/16 Chopart amputations at 11 months}. Complications of the trans-foot amputation occurred in 32% of patients. These included: dehiscence (13/116), partial flap loss (11/116), cellulitis (9/116), partial skin graft loss (3/116), and death (1/116). In summary, our study clearly shows that applying modern wound healing techniques and using plastic soft tissue techniques to preserve foot length can achieve a high long term salvage rate.