Predictive risk factors for lower limb amputations in patients with diabetic foot ulcer in correlation with Wagner’s grading
DOI:
https://doi.org/10.18203/2349-2902.isj20214748Keywords:
Diabetic foot ulcer, Lower extremity amputation, Wagner‘s gradingAbstract
Background: Lower extremity amputation in diabetic patients results in high morbidity causing poor quality of life despite high medical expenses. A correlate of risk factors with Wagner‘s grading of foot ulcers and their improvement with multidisciplinary team approach would form a basis for preventive diabetic foot care guidelines in health care policy. Objectives of current study were to assess the risk factors and role of multidisciplinary team approach in patients undergoing lower extremity amputations with diabetic footulcer with different Wagner‘s grading.
Methods: Prospective data of diabetic patients above eighteen years with foot ulcers admitted in departments of general surgery/general medicine at Vydehi Institute of medical sciences and research centre, between October 2017 to October 2019 were included. Multi-disciplinary treatment approach was adopted and treated accordingly. Patients were followed up for three months to reassess the risk factors for lower extremity amputation and correlated with Wagner‘s grading system and analyzed using descriptive statistical analysis, SPSS-21.
Results: fifty patients with Wagner’s grade 1-4 of which forty four (88%) males and six (12%) females. Four (8%) of the patients underwent major limb amputation. 18% underwent minor amputation and 16% SSG. 54% were grade 3,4 on day 1 and 24% patients were grade 3, 4 and 5 after 3 months of follow up (p=0.034).
Conclusions: Clinical assessment of diabetic foot ulcer and identification of risk factors for the nonhealing predicts the favourable outcome in the management of diabetic foot combined with multi-disciplinary team approach strategy.
References
Apelqvist J, Bakker K, van Houtum W, Nabuurs-Franssen M, Schaper N. International consensus and practical guidelines on the management and the prevention of the diabetic foot. Diab Metab Res Rev. 2000;16(S1):S84-92.
Ibrahim A. IDF Clinical practice recommendation on the diabetic foot: a guide for healthcare professionals. Diab Res Clin Pract. 2017;127:285-7.
Armstrong D, Boulton A, Bus S. Diabetic foot ulcers and their recurrence. New Eng J Med. 2017;376(24): 2367-75.
Hoe J, Koh WP, Jin A, Sum CF, Lim SC, Tavintharan S. Predictors of decrease in ankle– brachial index among patients with diabetes mellitus. Diab Med. 2012;29(9):e304-7.
Srinivasan K, Mohan A. Impact of multidisciplinary team approach in the management of Diabetic foot for a favourable outcome. Saudi J Med. 2018;3(4):119-24.
Parmar G, Vegad K. Effectiveness of vacuum-assisted closure (VAC) versus surgical debridement in the management of diabetic foot ulcerations. New Indian J Surg. 2019;10(3):289-92.
Everett E, Mathioudakis N. Update on management of diabetic foot ulcers. Ann New York Acad Sci. 2018;1411(1):153-65.
Sadriwala QS, Gedam BS, Akhtar MA. Risk factors of amputation in diabetic foot infections. Int Surg J. 2018;5:1399-402.
Surriah MH, Al-Imari ANK, Bakkour AM, Al-Asadi RRJ. Predictive value of the risk factors for amputation of lower extremity in patients with diabetic foot in Al-Karama teaching hospital. Int Surg J. 2019;6:1549-55.
Martinez- De Jesus FR. Validation of the ischemia severity scale (ISS) based on non- invasive vascular assessments for outcomes prediction in diabetic foot wounds. Int Surg J. 2020;41:52-9.
Elizabeth G, Craig M, Jordon G. Smart wound dressings for diabetic chronic wounds. Bioengineering. 2018;5:51.
Lavery L, Armstrong D, Murdoch D, Peters E, Lipsky B. Validation of the Infectious diseases society of America's diabetic foot infection classification system. Clin Infect Dis. 2007;44(4):562-5.
van Asten S, Mithani M, Peters E, La Fontaine J, Kim P, Lavery L. Complications during the treatment of diabetic foot osteomyelitis. Diab Res Clin Practice. 2018;135:58-64.
Elraiyah T, Domecq J, Prutsky G, Tsapas A, Nabhan M, Frykberg R, et al. A systematic review and meta-analysis of débridement methods for chronic diabetic foot ulcers. J Vascular Surg. 2016;63(2):37S-45S.e2.
Parmar G, Vegad K. Effectiveness of vacuum-assisted closure (VAC) versus surgical debridement in the management of diabetic foot ulcerations. New Indian J Surg. 2019;10(3):289-92.
Anderson J, Wallin K, Spencer L. Split thickness skin grafts for the treatment of non- healing foot and leg ulcers in patients with diabetes: a retrospective review. Diab Foot Ankle. 2012;3(1):10204.
Yazdanpanah, L, Nasiri, M, Adarvishi S. Literature review on the management of diabetic footulcer. World J Diab. 2015;6:37-53.
Hussain, Z, Thu, HE, Shuid AN, Katas H, Hussain F. Recent advances in polymer- based wound dressings for the treatment of diabetic foot ulcer: An overview of state-of- the-art. Curr Drug Targets. 2017;18:45-9.
Thompson P, Langemo D, Hunter S, Hanson D, Anderson J. Offloading diabetic foot ulcers. Advances in skin and wound care. 2006;19(1):15-9.
Everett E, Mathioudakis N. Update on management of diabetic foot ulcers. Ann New York Acad Sci. 2018;1411(1):153-65.
Pu D, Lei X, Leng W, Zheng Y, Chen L, Liang Z, et al. Lower limb arterial intervention or autologous platelet-rich gel treatment of diabetic lower extremity arterial disease patients with foot ulcers. Ann Translat Med. 2019;7(18):485.
Lazzarini PA, Hurn SE, Fernando ME, Jen SD, Kuys SS, Kamp MC, Reed LF. Prevalence of foot disease and risk factors in general inpatient populations: a systematic review and meta-analysis. BMJ. 2015;5(11):e008544.
Sadriwala QS, Gedam BS, Akhtar MA. Risk factors of amputation in diabetic foot infections. Int Surg J. 2018;5:1399-402.
Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Harkless LB, Boulton AJMM. 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.
Surriah MH, Al-Imari ANK, Bakkour AM, Al-Asadi RRJ. Predictive value of the risk factors for amputation of lower extremity in patients with diabetic foot in Al-Karama teaching hospital. Int Surg J. 2019;6:1549-55.
Paul S, Das DK. A clinicopathogical study on diabetic foot ulcer with special reference to the causative factors and its management. Int Surg J. 2019;6:1540-4.
Chethan L, Amith KM. Clinicopathological study and management of diabetic foot. Int Surg J. 2017;4:3928-32.
Das DK. Lower sensitivity of ankle-brachial index measurements among people suffering with diabetes-associated vascular disorders: A systematic review. SAGE Med. 2010;7:1-5.
Edakkepuram U, Sheeja PC, Gopi EV. A prospective cohort study of hypoalbuminemia as risk factor of wound healing in diabetic foot: a study from tertiary hospital in south India. Int Surg J. 2017;4:3141-5.
Anand AM. Correlation of CRP level with glycemic control in diabetic foot patients and its sequelae. Int Surg J. 2017;4:4006-9.
Hadavand F, Amouzegar A, AmidH. Pro-Calcitonin, erythrocyte sedimentation rate and c - reactive protein in predicting diabetic foot ulcer characteristics; a cross sectional study. Arch Acad Emerg Med. 2019;7(1): e37.
Amouzegar A. Hemoglobin A1c is a predictor of healing rate in diabetic wounds. J Invest Dermatol. 2011;131(10):2121-7.
Sadriwala QS, Gedam BS, Akhtar MA. Risk factors of amputation in diabetic foot infections. Int Surg J. 2018;5:1399-40.
