Reducing the menace of major lower limb amputations in Diabetic Foot Syndrome

Abstract

Background: Major lower limb amputations are the commonest form of amputation perform worldwide. Until recently, diabetic foot syndrome is one of the major causes, second only to trauma in the developing countries but in the last few years it has taken the lead. The incidence of major lower limb amputation has been very high in this region of the world compared to developed countries, where most of the amputations due to diabetic foot syndrome had been minor ones. This is due to early presentation and aggressive wound management by the plastic surgeons. We reviewed our protocol so as to elucidate the role of plastic surgery service in reducing the menace of major amputations in patients with diabetic foot syndrome.

Methods: This is a retrospective study comparing the incidence of major lower limb amputations due to diabetic foot syndrome in the 5 years before the availability of plastic surgery service (PSS) and the first 5 years of this service in Irrua Specialist Teaching Hospital, Irrua. All the data were retrieved from the patients’ case-notes from the Medical Records Department.

Results: The hospital admission of patients with Wagner’s Grade 2 to 5 diabetic foot syndrome has increase significantly from 85 before the plastic surgery service to 167 during the period reviewed. The male to female ratio has reduced from about 3.5:1 to 2.2:1 which indicated that there is increase in female presentation and admission. The number of major lower limb amputations before plastic surgery services was 45, accounting for 53% of all in-patients while it was 40 thereafter accounting for 24%.

Conclusion: The availability of plastic surgery service in the hospital and development of protocol that all patients with diabetic foot ulcers should be co-managed primarily by endocrinologist and plastic surgeon, while the Orthopaedic surgeon is only involved in patients with established osteomyelitis or when all attempts to salvage the limb had failed. This resulted in significant reduction in major lower limb amputation and encouraged hospital presentation of patients.

Keywords: Plastic Surgery; Reduction; Major lower limb amputation; Diabetic foot syndrome