This study was undertaken to examine the hypothesis that the initial high limb salvage rate in patients with diabetes who are treated aggressively with a multidisciplinary approach to management of severe, chronic lower extremity wounds is durable and cost effective. In 1991 a cohort of 41 patients with diabetes with severe, chronic foot wounds was selected by a neutral, blinded observer who had no knowledge of the outcomes from a group of 101 consecutive such patients who had been treated at our wound center from 1983 to 1990. All had limb-threatening lesions, scoring 3 to 4 on the Wagner scale, were treated for at least 7 days with adjunctive hyperbaric oxygen, and had photographic and medical documentation. Durability of wound repair was examined in 1991 and 1993. Initial limb salvage was 85%. Mean hospital charges were $31,264, including average hyperbaric charges of $15,000. At the initial review, 28 of the patients with previously salvaged limbs (80%) were contacted. Of the 28 patients, 27 remained intact (96%). The mean durability of repair was 2.6 years. At the second review, the mean duration of repair in surviving patients was 4.6 years with no further expenditures relative to the salvaged limb. In patients who died, average durability was 3.4 years, also without additional expenditure referable to the salvaged extremity. Most complex lower extremity lesions were healed by a comprehensive wound care program which included vascular surgery and hyperbaric oxygen. The results were durable, and the treatment was cost effective and humane compared with early amputation.