Diabetic foot ulcer: a clinical study
DOI:
https://doi.org/10.18203/2349-2902.isj20163581Keywords:
Diabetes mellitus, Foot ulcer, Conservative treatmentAbstract
Background: Diabetic foot ulcer is one of the common presentations of diabetic foot. The diabetic foot may be defined as a group of syndromes in which neuropathy, ischemia and infection lead to tissue breakdown, resulting
in morbidity and possible amputation (World Health Organization, 1995) According to the diabetes atlas 2013 published by the International Diabetes Federation, the number of people with diabetes in India currently is 65.1
million, which is expected to rise to 142.7 million by 2035. The objective of the present study was to evaluate the various presentations of diabetic foot ulcer like, resistant deep infections, ulcer with cellulitis, severe ischemia leading on to gangrene and to study percentage of surgical intervention like debridement, minor/major amputation.
Methods: 60 patients of diabetic foot ulcer admitted in the department of general surgery at Guwahati Medical College, Guwahati during the period of August 2014 to August 2015.
Results: The highest number of patients was seen in the age group of 56-65 years. The male to female ratio was approximately 1.4:1. Surgical complications are more common in men commonest presenting lesion was ulcers. Commonest site of lesion was toes. Trivial trauma is the initiating factor in about 68% of the cases. Most of the patients had history of diabetes mellitus between 6 to 10 years. Most common microorganisms grown from culture taken from the lesion was Staphylococcus aureus. Conservative treatment consists of control of diabetes with human insulin along with antibiotics along and simple dressing, wound debridement, slough excision, followed by dressing. Split skin grafting, disarticulation, bellow knee amputation, and above knee amputation, were the other modes of treatment. There was no mortality in present study.
Conclusions: Management of the surgical patient with diabetes should be based on knowledge of the path physiology of diabetes and on an assessment of its chronic complications.
References
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047-53.
Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293:217-28.
Reiber GE, Vileikyte L, Boyko EJ, del Aguila M, Smith DG, Lavery LA, et al. Causal pathways for incident lower extremity ulcers in patients with diabetes from two settings. Diabetes Care. 1999;22:157–62.
Yazdanpanah L, Nasiri M, Adarvishi S. Literature review on the management of diabetic foot ulcer. World J Diabetes. 2015;6(1):37-53.
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87:4-14.
Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011;94:311-21.
Teodorescu VJ, Chen C, Morrissey N, Faries PL, Marin ML, Hollier LH. Detailed protocol of ischemia and the use of non-invasive vascular laboratory testing in diabetic foot ulcers. Am Jr of Surgery. 2004;187(5):75-80.
Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: 6.global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pr. 2013;94(3):311-21.
Wheel Lock FC Jr, Gibbons GW, Campbell D. Study of foot lesions in diabetics. Ann Surg. 1969;99:776.
Mummidi DS, Dugar D, Mishra RK, Mohapatra JS, Houghton T. Clinico pathological Study: Management Of Diabetic Foot And Its Complications. J Pharm Biomed Sci. 2015;5(4):308-11.
Mayfield JA, Reiber GE, Nelson RG, Greene T. A foot risk classification system to predict diabetic amputation in Pima Indians. Diabetes care. 1996;19(7):704- 9.
Apelqvist J, Castenfors J, Larsson J, Stenström A, Agardh CD. Wound classification is more important than site of ulceration in the outcome of diabetic foot ulcers. Diabet Med. 1989;6(6):526-30.
Quari FA, Akbar D. Diabetic foot. Presentation and treatment. Saudi medical journal. 2000:21(5);443-6.
Reiber GE, Lipsky BA, Gibbons GW: The burden of diabetic foot ulcers. Am J Surg. 1998;176(2):5-10.
Grayson ML, Gibbons GW, Habershaw GM, Freeman DV, Pomposelli FB, Rosenblum BI, et al. Use of ampicillin/sulbactam versus imipenem /cilastatin in the treatment of limb-threatening foot infections in diabetic patients. Clin Infect Dis. 1994;18:683-93.
Wheat LJ, Allen SD, Henry M, Kernek CB, Siders JA, Kuebler T, et al. Diabetic foot infections: bacteriologic analysis. Arch Intern Med. 1986;146:1935-40.
Hughes CE, Johnson CC, Bamberger DM, Reinhardt JF, Peterson LR, Mulligan ME, et al. Treatment and long-term follow-up of foot infections in patients with diabetes or ischemia: a randomized, prospective, double-blind comparison of cefoxitin and ceftizoxime. Clin Ther. 1987;10:36–49.
Collens WS, Vlahos E, Dobkin Gb, Neumann E, Rakow R, Altman M, et al. Conservative management of gangrene in the diabetic patient. Bull Soc Int Chir. 1962;21:473-80.
Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Harkless LB, Boulton AJ. A comparison of two diabetic foot ulcer classification systems: the Wagner and the University of Texas wound classification systems. Diabetes Care. 2001;24(1):84-8.
