Abstract
Aim The diabetic foot attack (DFA) is perhaps the most devastating
form of diabetic foot infection, presenting with rapidly progressive skin
and tissue necrosis, threatening both limb and life. However, clinical
outcome data in this specific group of patients are not
available.
Methods Analysis of 106 consecutive patients who underwent emergency
hospitalisation for DFA (TEXAS Grade 3B or 3D and Infectious Diseases
Society of America (IDSA) Class 4 criteria). Outcomes evaluated were: 1)
Healing 2) major amputation 3) death 4) not healed. The first outcome
reached in one of these four categories over the follow-up period
(18.4±3.6 months) was considered. We also estimated amputation free
survival.
Results Overall, 57.5% (n=61) healed, 5.6%
(n=6) underwent major amputation, 23.5% (n=25) died
without healing and 13.2% (n=14) were alive without healing.
Predictive factors associated with outcomes were: Healing (age<60,
p=0.0017; no Peripheral arterial disease (PAD) p= 0.002; not
on dialysis p=0.006); major amputation (CRP>100
mg/L, p=0.001; gram+ve organisms, p=0.0013;
dialysis, p= 0.001), and for death (age>60, p=
0.0001; gram+ve organisms p=0.004; presence of PAD,
p=0.0032; CRP, p=0.034). The major amputation free survival
was 71% during the first 12 months from admission, however it had
reduced to 55.4% by the end of the follow-up period.
Conclusions In a unique population of hospitalised individuals with
DFA, we report excellent healing and limb salvage rates using a dedicated
protocol in a multidisciplinary setting. An additional novel finding was the
concerning observation that such an admission was associated with high
18-month mortality, almost all of which was after discharge from
hospital.
Multidisciplinary Limb Salvage Service: Reducing Major Amputations in Diabetic Foot Infections
