Yıl: 2017 Cilt: 47 Sayı: 4 Sayfa Aralığı: 1109 - 1116 Metin Dili: İngilizce İndeks Tarihi: 29-07-2022

Evaluation of major and minor lower extremity amputation in diabetic foot patients

Öz:
Background/aim: We evaluated the existing risk factors with clinical results in patients who underwent major and minor amputation of the lower extremity as a result of diabetic foot ulcers (DFUs). Materials and methods: We retrospectively studied 107 patients who had undergone lower extremity amputation. The patients were divided into minor (Group 1, n = 75) and major (Group 2, n = 32) amputation groups. On clinical evaluation, the type of surgery performed, smoking history, comorbidities, duration of diabetes mellitus (DM) diagnosis, duration of DFU presence, peripheral neuropathy, peripheral arterial disease, results of deep tissue culture, length of hospitalization, and blood parameters were investigated. Results: In Group 2, mean hospitalization time was significantly longer than in Group 1 (P < 0.05). The proportion of patients with Wagner Grade 4 was significantly higher in Group 2 than in Group 1 (P < 0.05). The duration of DM and DFU was significantly longer in Group 2 (P < 0.05). The number of polymicrobial agents was significantly higher in Group 1 (P < 0.05). Conclusion: In our study, the most important risk factors that led to major amputation in patients with DFU were age, Wagner classification, duration of DM, duration of DFU, and C-reactive protein level.
Anahtar Kelime:

Konular: Cerrahi
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Martins-Mendes D, Monteiro-Soares M, Boyko EJ, Ribeiro M, Barata P, Lima J, Soares R. The independent contribution of diabetic foot ulcer on lower extremity amputation and mortality risk. J Diabetes Complicat 2014; 28: 632-638.
  • 2. Abbott CA, Carrington AL, Ashe H, Bath S, Every LC, Griffiths J, Hann AW, Hussein A, Jackson N, Johnson KE et al. The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabet Med 2002; 19: 377-384.
  • 3. Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet 2005; 366: 1719-1724.
  • 4. Ramsey SD, Newton K, Blough D, McCulloch DK, Sandhu N, Reiber GE, Wagner EH. Incidence, outcomes, and cost of foot ulcers in patients with diabetes. Diabetes Care 1999; 22: 382- 387.
  • 5. Tallis A, Motley TA, Wunderlich RP, Dickerson JE Jr, Waycaster C, Slade HB. Clinical and economic assessment of diabetic foot ulcer debridement with collagenase: results of a randomized controlled study. Clin Ther 2013; 35: 1805-1820.
  • 6. Yesil S, Akinci B, Yener S, Bayraktar F, Karabay O, Havitcioglu H, Yapar N, Atabey A, Kucukyavas Y, Comlekci A et al. Predictors of amputation in diabetics with foot ulcer: single center experience in a large Turkish cohort. Hormones 2009; 8: 286-295.
  • 7. Monteiro-Soares M, Dinis-Ribeiro M.See comment in PubMed Commons below External validation and optimisation of a model for predicting foot ulcers in patients with diabetes. Diabetologia 2010; 53: 1525-1533.
  • 8. Oh TS, Lee HS, Hong JP. Diabetic foot reconstruction using free flaps increases 5-year-survival rate. J Plast Reconstr Aesthet Surg 2013; 66: 243-250.
  • 9. Struijs JN, Baan CA, Schellevis FG, Westert GP, van des Bos GA. Comorbidity in patients with diabetes mellitus: impact on medical health care utilization. BMC Health Serv Res 2006; 6: 84.
  • 10. Sun JH, Tsai JS, Huang CH, Lin CH, Yang HM, Chan YS, Hsieh SH, Hsu BR, Huang YY. Risk factors for lower extremity amputation in diabetic foot disease categorized by Wagner classification. Diabetes Res Clin Pract 2012; 95: 358-363.
  • 11. Unwin N. Comparing the incidence of lower extremity amputations across the world: the Global Lower Extremity Amputation Study. Diabet Med 1995; 12: 14-18.
  • 12. Wagner FW. A classification and treatment program for diabetic, neuropathic, and dysvascular foot problems. AAOS Instr Cours Lec 1979; 28: 143-165.
  • 13. Smieja M, Hunt DL, Edelman D, Etchells E, Cornuz J, Simel DL. Clinical examination for the detection of protective sensation in the feet of diabetic patients. J Gen Intern Med 1999; 14: 418- 424.
  • 14. Ragnarson TG, Apelqvist J. Prevention of diabetes-related foot ulcers and amputations: a cost-utility analysis based on Markov model simulations. Diabetologia 2001; 44: 2077-2087.
  • 15. Tseng CH, Tai TY, Chen CJ, Lin BJ. Ten-year clinical analysis of diabetic leg amputees. J Formos Med Assoc 1994; 93: 388- 392.
  • 16. Sun JH, Tsai JS, Huang CH, Lin CH, Yang HM, Chan YS, Hsie SH, Hsu BR, Huang YY. Risk factors for lower extremity amputation in diabetic foot disease categorized by Wagner classification. Diabetes Res Clin Pract 2012; 95: 358-363.
  • 17. Robbins JM, Strauss G, Aron D, Long J, Kuba J, Kaplan Y. Mortality rates and diabetic foot ulcers: is it time to communicate mortality risk to patients with diabetic foot ulceration? J Am Podiatr Med Assoc 2008; 98: 489-493.
  • 18. Flores Rivera AR. Risk factors for amputation in diabetic patients: a case-control study. Arch Med Res 1998; 29: 179-184.
  • 19. Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Risk factors predicting lower extremity amputations in patients with NIDDM. Diabetes Care 1996; 19: 607-612.
  • 20. Lipsky BA, Sheehan P, Armstrong DG, Tice AD, Polis AB, Abramson MA. Clinical predictors of treatment failure for diabetic foot infections: data from a prospective trial. Int Wound J 2007; 4: 30-38.
  • 21. Jeffcoate WJ, Harding KG. Diabetic foot ulcers. Lancet 2003; 361: 1545-1551.
  • 22. Young MJ, Breddy JL, Veves A, Boulton AJ. The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds: a prospective study. Diabetes Care 1994; 17: 557- 560.
  • 23. Boyko EJ, Ahroni JH, Stensel V, Forsberg RC, Davignon DR, Smith DG. A prospective study of risk factors for diabetic foot ulcer. The Seattle diabetic foot study. Diabetes Care 1999; 22: 1036- 1042.
  • 24. Miyajima S, Shirai A, Yamamoto S, Okada N, Matsushita T. Risk factors for major limb amputations in diabetic foot gangrene patients. Diabetes Res Clin Pract 2006; 71: 272-279.
  • 25. Armstrong DG, Lavery LA, Harkless LB. Validation of a diabetic wound classification system. The contribution of depth, infection, and ischemia to risk of amputation. Diabetes Care 1998; 21: 855-859.
  • 26. Frykberg RG. An evidence-based approach to diabetic foot infections. Am J Surg 2003; 186: 44-54.
  • 27. Lipsky BA, Pecoraro RE, Wheat LJ. The diabetic foot: soft tissue and bone infection. Infect Dis Clin North Am 1990; 4: 409-432.
  • 28. Dang CN, Prasad YDM, Boulton AJM, Jude EB. Methicillinresistant Staphylococcus aureus in the diabetic foot clinic: a worsening problem. Diabet Med 2003; 20: 159-161.
APA Ozan F, Gürbüz K, Çelik İ, BEŞTEPE DURSUN Z, uzun e (2017). Evaluation of major and minor lower extremity amputation in diabetic foot patients. , 1109 - 1116.
Chicago Ozan Fırat,Gürbüz Kaan,Çelik İlhami,BEŞTEPE DURSUN Zehra,uzun erdal Evaluation of major and minor lower extremity amputation in diabetic foot patients. (2017): 1109 - 1116.
MLA Ozan Fırat,Gürbüz Kaan,Çelik İlhami,BEŞTEPE DURSUN Zehra,uzun erdal Evaluation of major and minor lower extremity amputation in diabetic foot patients. , 2017, ss.1109 - 1116.
AMA Ozan F,Gürbüz K,Çelik İ,BEŞTEPE DURSUN Z,uzun e Evaluation of major and minor lower extremity amputation in diabetic foot patients. . 2017; 1109 - 1116.
Vancouver Ozan F,Gürbüz K,Çelik İ,BEŞTEPE DURSUN Z,uzun e Evaluation of major and minor lower extremity amputation in diabetic foot patients. . 2017; 1109 - 1116.
IEEE Ozan F,Gürbüz K,Çelik İ,BEŞTEPE DURSUN Z,uzun e "Evaluation of major and minor lower extremity amputation in diabetic foot patients." , ss.1109 - 1116, 2017.
ISNAD Ozan, Fırat vd. "Evaluation of major and minor lower extremity amputation in diabetic foot patients". (2017), 1109-1116.
APA Ozan F, Gürbüz K, Çelik İ, BEŞTEPE DURSUN Z, uzun e (2017). Evaluation of major and minor lower extremity amputation in diabetic foot patients. Turkish Journal of Medical Sciences, 47(4), 1109 - 1116.
Chicago Ozan Fırat,Gürbüz Kaan,Çelik İlhami,BEŞTEPE DURSUN Zehra,uzun erdal Evaluation of major and minor lower extremity amputation in diabetic foot patients. Turkish Journal of Medical Sciences 47, no.4 (2017): 1109 - 1116.
MLA Ozan Fırat,Gürbüz Kaan,Çelik İlhami,BEŞTEPE DURSUN Zehra,uzun erdal Evaluation of major and minor lower extremity amputation in diabetic foot patients. Turkish Journal of Medical Sciences, vol.47, no.4, 2017, ss.1109 - 1116.
AMA Ozan F,Gürbüz K,Çelik İ,BEŞTEPE DURSUN Z,uzun e Evaluation of major and minor lower extremity amputation in diabetic foot patients. Turkish Journal of Medical Sciences. 2017; 47(4): 1109 - 1116.
Vancouver Ozan F,Gürbüz K,Çelik İ,BEŞTEPE DURSUN Z,uzun e Evaluation of major and minor lower extremity amputation in diabetic foot patients. Turkish Journal of Medical Sciences. 2017; 47(4): 1109 - 1116.
IEEE Ozan F,Gürbüz K,Çelik İ,BEŞTEPE DURSUN Z,uzun e "Evaluation of major and minor lower extremity amputation in diabetic foot patients." Turkish Journal of Medical Sciences, 47, ss.1109 - 1116, 2017.
ISNAD Ozan, Fırat vd. "Evaluation of major and minor lower extremity amputation in diabetic foot patients". Turkish Journal of Medical Sciences 47/4 (2017), 1109-1116.