Trends in the presentation and surgical management of the acute diabetic foot
Authors: Adam,D. J.;Raptis,S.;Fitridge,R. A.
Publication: European Journal of Vascular and Endovascular Surgery
Background: This study examines trends in the presentation and surgical management of acute diabetic foot problems in a single institution. Method. Prospective audit of all diabetic patients who had a primary procedure for critical lower limb ischaemia (CLI) and/or foot sepsis between 1st January 1990 and 31st December 2002. Primary and secondary intervention, mortality and limb salvage rate within 6 weeks of the index procedure were recorded. Results. There were 661 patients (417 men and 244 women of median age 69, range 31-99, years) with 799 affected limbs. CLI alone was present in 625 (78%) limbs, combined CLI and foot sepsis in 53 (7%) and foot sepsis alone in 121 (15%). The primary intervention was minor amputation in 323 (40%) limbs, revascularisation in 288 (36%), major amputation in 185 (23%) and sympathectomy in three limbs. Within 6 weeks, 125 (16%) limbs required secondary intervention, the peri-procedural mortality rate was 38 of 924 (4%), and the limb salvage rates for patients with CLI, combined CLI and sepsis and sepsis alone were 66, 66 and 80%, respectively. There was a significant decline in the proportion of patients presenting with CLI alone and a significant increase in the proportion presenting with combined CLI and sepsis and sepsis alone. In patients with CLI alone, there was a significant increase in the primary major amputation rate and a significant decline in the minor amputation rate with no significant change in the revascularisation rate. Conclusion. There has been a progressive decline in the proportion of patients presenting with CLI alone and a greater proportion of patients presenting with an element of foot sepsis. In patients with CLI alone, the primary major amputation rate has increased at the expense of a decline in minor amputation rate. Â© 2005 Elsevier Ltd. All rights reserved.
KEYWORDS:acute disease;adult;aged;article;comorbidity;controlled study;diabetic foot;female;human;leg revascularization;limb amputation;limb ischemia;limb salvage;major clinical study;male;medical audit;medical record;mortality;priority journal;prospective study;risk factor;sepsis;surgical technique;sympathectomy;treatment planning;vascular surgery