Current Trends in Indications and Epidermiological Characteristics of Amputations in Nigeria

2020 ◽  
Author(s):  
Ekpenyong Christopher Edet
Keyword(s):  
Public Health ◽  
Diabetic Foot ◽  
Local Community ◽  
Arterial Disease ◽  
Economic Implications ◽  
Female Ratio ◽  
Upper And Lower Extremities ◽  
The Face ◽  
Peripheral Arterial ◽  
Epidemiological Characteristics

Background: Recently, we have witnessed a surge in the population of Diabetics and of course in the cases of Diabetic Foot Syndrome(DFS) requiring amputation. However, accepting amputation is difficult for patients and this has become a family or community decision to undergo amputation despite being a lifesaving procedure in most cases. Some patients have preferred to die with their gangrenous limbs in the face of ascending severe foot infection and septicemia rather than have an amputation. Aim: This study seeks to identify the current indications for amputation and its epidemiological characteristics in our hospital and by extension, our local community. Perhaps, this can be extrapolated and communicated as a Public Health warning and strategy to control the incidence, prevalence, and devastating effects of Amputation in our community. Methods: It was a descriptive, quantitative, and prospective study of the indications and epidemiological characteristics of Amputations in Uyo, Niger Delta region of Nigeria. This was done between the periods of January 2018 to December 2019 amongst patients who underwent Amputation at the University of Uyo Teaching Hospital, Uyo, Nigeria. Results: We did a total of 44 unilateral amputations of both upper and lower extremities. The age range was 19 to 71 years. The average age was 48.5 years they were 21 males and 23 females giving a Male: Female ratio of 1:1.1. The 4th to 6th decades of life had the highest number of amputations with a peak in the 5th decade. Diabetic Foot Gangrene (DFG) contributed the majority of 25 amputations (56.8%), most of which were in the 4th to 6th Decades, 23 (52.3%). They were 14 females (31.8%) and 11 males (25.0%) with DFG. Trauma contributed 14 amputations (31.8%), and most were in the 2nd to 4th decades of life but more were males 10 (22.7%) while females were 4 (9.1%). Fracture-Traditional BoneSetter-Gangrene (F-TBS-G) and Peripheral Arterial Disease each contributed 2 amputations (4.5%). Conclusion: The commonest indication for amputation was Diabetic Foot Gangrene(DFG) affecting patients in the 4th to 6th decades of life while Trauma, the 2nd commonest, affected patients in the 2nd to 4th decades of life. Therefore, in the face of the increasing prevalence of Diabetes in our society, Public Health measures aimed at early diagnosis and management of Diabetes as well as prevention of Trauma will reduce the rate of amputations, its attendant morbidity, and negative economic implications in our society.

scholarly journals A Study of the Risk Factors Predicting Amputation in Diabetic Foot

2021 ◽  
Vol 6 (3) ◽  
pp. 21-25
Author(s):  
Amara Simha Reddy. T ◽  
Prashant G.K.
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Medical Science ◽  
Significant Risk ◽  
Arterial Disease ◽  
Major Amputation ◽  
Foot Ulcers ◽  
Female Ratio ◽  
Male Female Ratio ◽  
Peripheral Arterial

Background: Diabetic foot ulcers are the main cause of non-traumatic lower extremity amputation. The objective of this study was to evaluate the risk factors for major amputation in diabetic foot patients. Materials & Methods: This open, single center, prospective and observational study conducted in Chalmeda Anand Rao Institute of Medical Science, Karimnagar for a period from Nov. 2018 to Dec. 2020 The patients admitted in General Surgery with diabetic foot problems were selected for the study with proper consent of patients and his/her attendants. Results: In this study Fifty patients were admitted to the diabetic wound in Department of Surgery for foot ulcers between Nov 2018 to Dec 2020. Among the 50 patients, Male: Female ratio was 4.6:1. out of which 41 (82.0%) were male, 18 (36.0%) belonged to the 50 to 59 years age group, 15 (30.0%) were having complaints for Ulcer, 15 (30.0%) were smoker. The Amputation rate was 42.0%. Conclusion: In the results of analysis, poor glycemic control, peripheral arterial disease, peripheral neuropathy and higher Wagner grade are significant risk factors for amputation in diabetic foot infection. Keywords: Diabetic foot, Wagner grading, HbA1c, TLC, Albumin.

Outcomes after Emergency Admission with a Diabetic Foot Attack Indicate a High Rate of Healing and Limb Salvage But Increased Mortality: 18-Month Follow-up Study

2020 ◽  
Author(s):  
Erika Vainieri ◽  
Raju Ahluwalia ◽  
Hani Slim ◽  
Daina Walton ◽  
Chris Manu ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Diabetic Foot ◽  
Emergency Admission ◽  
Arterial Disease ◽  
Major Amputation ◽  
Outcome Data ◽  
High Rate ◽  
Free Survival ◽  
Peripheral Arterial

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.

Healing Rate of Diabetic Foot Wounds When Treated with Serial Debridement in the Presence of Antithrombotic Therapy

2021 ◽  
Vol 111 (4) ◽  
Author(s):  
Jack Route
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Antithrombotic Therapy ◽  
Healing Rate ◽  
Standard Of Care ◽  
Significant Negative Correlation ◽  
Arterial Disease ◽  
Wound Area ◽  
Negative Effect ◽  
Peripheral Arterial

Background Previous study indicates that pharmacologic antithrombotic therapy may be an inhibitory factor for wound healing and should merit consideration among the other core factors in wound healing optimization. Methods This study provides a retrospective analysis of the effect of antithrombotic therapy on wound healing rates of uncomplicated diabetic foot ulcerations. Wounds treated with standard of care in the presence of clinical anticoagulation were compared to control wounds. Results The results indicate a statistically significant negative correlation between antithrombotic therapy and diabetic foot wound healing rate. This represents the first study focusing on this correlation in the uncomplicated diabetic foot wound. Conclusions This retrospective study demonstrates that antithrombotic therapy has a statistically significant negative effect on healing rates of uncomplicated diabetic foot ulcerations. Both wound area and depth improvement over 4 weeks was significantly better in treated patients who were not on antithrombotic therapy for comorbidity not associated with peripheral arterial disease.

Pro- and Anti-Angiogenic Factors: Their Relevance in Diabetic Foot Syndrome—A Review

Angiology ◽  
2021 ◽  
pp. 000331972110426
Author(s):  
Martyna Schönborn ◽  
Patrycja Łączak ◽  
Paweł Pasieka ◽  
Sebastian Borys ◽  
Anna Płotek ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Healing Process ◽  
Arterial Disease ◽  
Angiogenic Factors ◽  
Diabetic Foot Syndrome ◽  
Tissue Loss ◽  
Comprehensive Treatment ◽  
Diabetic Patients ◽  
Impaired Wound Healing ◽  
Peripheral Arterial

Peripheral arterial disease can involve tissue loss in up to 50% of patients with diabetic foot syndrome (DFS). Consequently, revascularization of narrowed or occluded arteries is one of the most common forms of comprehensive treatment. However, technically successful angioplasty does not always result in the healing of ulcers. The pathomechanism of this phenomenon is still not fully understood, but inadequate angiogenesis in tissue repair may play an essential role. Changes in pro- and anti-angiogenic factors among patients with DFS are not always clear and conclusive. In particular, some studies underline the role of decreased concentration of pro-angiogenic factors and higher levels of anti-angiogenic mediators. Nevertheless, there are still controversial issues, including the paradox of impaired wound healing despite high concentrations of some pro-angiogenic factors, dynamics of their expression during the healing process, and their mutual relationships. Exploring this process among diabetic patients may provide new insight into well-known methods of treatment and show their real benefits and chances for improving outcomes.

scholarly journals SKRINING KAKI DIABTES UNTUK DETEKSI DINI LUKA KAKI DIABETES PADA PASIEN DIABETES

2020 ◽  
Vol 6 (2) ◽  
pp. 192-198
Author(s):  
Juhelnita Bubun ◽  
Saldy Yusuf ◽  
Yuliana Syam ◽  
Wahyu Hidayat ◽  
Suharno Usman
Keyword(s):  
Peripheral Arterial Disease ◽  
Scoping Review ◽  
Diabetic Foot ◽  
Full Text ◽  
Arterial Disease ◽  
Key Word ◽  
Diabetic Foot Screening ◽  
Peripheral Arterial

Latar Belakang: Prognosis LKD yang tidak dirawat dengan baik akan berdampak buruk yaitu amputasi bahkan kematian sehingga dibutuhkan tindakan pencegahan yaitu skrining kaki diabetes. Tujuan dari review ini, untuk mengetahui metode skrining kaki diabetes untuk mencegah terjadi luka kaki diabetes (LKD). Metode database yang digunakan pada pencarian artikel yaitu pubmed, wiley dan science direct. Hasil: kata kunci yang digunakan diabetic foot screening OR diabetes foot screening jumlah artikel yang didapatkan   39 artikel dari tiga database dan artikel yang menjadi kriteria inklusi artikel, artikel tahun 2013-2018, merupakan hasil penelitian, sesuai tema  scoping review dan artikel full text, sehingga terdapat empat artikel yang terinklusi. Dari artikel tersebut dua artikel yang membahas metode skrining kaki diabetes untuk mendeteksi neuropati dan dua artikel yang membahas metode skrining kaki diabetes untuk mendeteksi angiopati. Skrining kaki diabetes untuk mendeteksi neuropati dapat menggunakan metode sudoscan yang dapat mendeteksi 34% tidak ada neuropati, tanpa gejala 69% dan dengan gejala 61,7%. Metode Ipswich touch test (IpTT) dapat digunakan oleh tenaga non professional di rumah dan klinik dalam mendeteksi neuropati dengan sensitivitas 78,3% dan 81,2%, spesifitas 93,9% dan 96,4%. Metode dalam mendeteksi angiopati adalah ankle brachialis index (ABI). Kombinasi hasil palpasi nadi yang lemah /hilang dan ABI yang abnormal menghasilkan sensitivitas dan nilai prediksi negatif tertinggi (92,3 % dan 89,8%) penyebab peripheral arterial disease (PAD). Kesimpulan: metode skrining kaki diabetes untuk mendeteksi neuropati terdiri atas beberapa metode yang aman untuk digunakan. ABI dapat digunakan mendeteksi PAD. Key word: skrining kaki diabetes, neuropati, angiopati

Diabetic Foot and Footwear

2015 ◽  
Vol 19 (1) ◽  
pp. 1-10 ◽  
Author(s):  
Luximon Ameersing ◽  
Ganesan Balasankar ◽  
Younus Abida
Keyword(s):  
Diabetic Foot ◽  
Plantar Pressure ◽  
Arterial Disease ◽  
Sensory Loss ◽  
Foot Deformities ◽  
Diabetic Patients ◽  
Body Parts ◽  
Foot Ulceration ◽  
Materials Used ◽  
Peripheral Arterial

Diabetes mellitus is one of the most common diseases around the world, and mainly affects the foot among the human body parts. The main causes of the diabetic foot are neuropathy, peripheral arterial disease and foot deformities; it leads to foot ulceration. Generally, sensory loss, high plantar pressure, foot deformities, inappropriate footwear, blindness, and age are the causing risk factors for developing foot ulceration in diabetic patients. Foot ulceration will result in prolonged hospitalization, high medical expenses, and serious complications with lower extremity amputation. For a long time, appropriate footwear has been recommended by physicians for reducing plantar pressure to prevent foot ulceration, the risk of amputation, and re-ulceration. A review is provided in this article towards the existing literature on the causes and prevalence of the diabetic foot, foot ulceration, off-loading pressure, footwear modification for different types of diabetic foot deformities, and types of footwear and textile materials used in footwear insoles for healing purposes.

Antimicrobial therapy in infectious complications of diabetic foot

2014 ◽  
Vol 21 (1) ◽  
pp. 55-62
Author(s):  
Ioan Marin ◽  
Roxana Zaharia ◽  
Leonard Lupu ◽  
Emilia Rusu ◽  
Gabriela Radulian
Keyword(s):  
Antimicrobial Therapy ◽  
Diabetic Foot ◽  
Arterial Disease ◽  
Infectious Complications ◽  
Wound Management ◽  
Successful Outcome ◽  
Surgical Interventions ◽  
Diabetic Foot Infections ◽  
Definitive Therapy ◽  
Peripheral Arterial

Abstract Background and aims: The treatment of diabetic foot complications is combined, surgical and medical. The aim of our study was to assess the results of antimicrobial therapy in diabetic foot infections. Material and methods: 100 patients with diabetic foot infections admitted in the Surgery Clinic “I. Juvara” between December 2010 and February 2011 were analyzed. Results: Mean age at presentation was 58.4±9.74 years for women and 63.2±10.53 years for men. Mean diabetes duration was 12.3 years in men and 15.7 years in women. Patients with peripheral arterial disease represented 45% of cases, patients with neuropathy represented 16% of cases and patients with both conditions 39% of the cases. 41 patients suffered minor surgical interventions, 36 patients experienced minor amputations and 23 major amputations (below or above the knee). Antibiotic treatment included cephalosporins, fluoroquinolones and combinations with Metronidazole. After treatment, 74% of patients had a good postoperative evolution. For 26 patients a change of the antibiotic was necessary but only in 10 cases this was made according to antibiogram. Conclusions: Surgical debridement and wound management, carefully chosen antimicrobial therapy and treatment of comorbidities are very important for a successful outcome. Initial empirical antibiotic selection should be followed by culture-guided definitive therapy.

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