To evaluate the functional outcome, morbidity, and viability of foot salvage in diabetic patients.
MATERIALS AND METHODS: This prospective case series was conducted from March 2007 to December 2012 at the department of surgery Pakistan Ordnance Factories Hospital, Wah Cantt, Pakistan. 123 males and 26 female patients were included in the study. All the patients were treated after getting admitted in the hospital and
wounds were managed with daily dressings,
nursing care and
debridement of necrotic tissue with adequate
antibiotic coverage.
RESULTS: In total, 149 patients (mean age: 56±7.52 years) with 171
amputations were included in the study. The mean duration of
diabetes mellitus (DM) was 9±4.43 years. Ninety-seven percent of the patients were diagnosed with type 2 DM.
Wound debridement was performed under
general anesthesia in 48 (33.2%) patients, whereas
local anesthesia was used for the rest of the patients after having good
glycemic control and improvement in general health. The most common pathogen isolated from the infected
wounds was Staphylococcus aureus in approximately 46% cases. Regarding the types of
amputation, partial toe
amputation was performed in 21 (12.2%) cases, second-toe
amputation in 60 (35%) cases, hallux
amputation in 41 (24%) cases, multiple toe
amputations in 29 (17%) cases, bilateral feet involvement was observed in 16 (9.3%) cases, and transmetatarsal
amputation was performed in 4 (2.3%) cases. The
wounds healed well except in 19 cases where
amputation had to be revised to a more proximal level. Thirty-nine patients died during the study period: 3 died of
wound-related complications and 36 died of systemic complications.
CONCLUSION: With the ever-increasing epidemic of DM, the number of patients with
diabetic foot ulcers has also significantly risen. Early surgical management with good
glycemic control and foot care with close monitoring can decrease
amputations and thus foot salvage can be successfully achieved.