This is a review of 365 diabetic cases with severe forms of syndrome of diabetic foot (SDF) surgically treated in period of 20 yrs (1970-1989) at the Surgical Hospital, University Clinical Center in Nis. Comparative analysis of the clinical material, divided into two groups, the former and the latter periods of ten yrs, revealed essential difference in surgical treatment of SDF where advantages of modern surgical approach to treatment of this acute and severe problem have been clearly evidenced. After establishing the role and importance of surgical therapy in a complex, multidisciplinary treatment of SDF; practical guidelines for everyday surgical practice have been recommended for achieving better results to be reflected in decrease of mortality, increased number of spared legs and feet, or, in cases where amputation cannot be avoided, successful rehabilitation and application of prosthesis in severe diabetic patients.