Impact of Multidisciplinary Team Approach in the Management of Diabetic Foot for a Favourable Outcome

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Impact of Multidisciplinary Team Approach in the Management of Diabetic Foot for a Favourable Outcome

Journal Title: Saudi Journal of Medicine - Year 2018, Vol 3, Issue 4

Abstract

Abstract:Lower extremity amputation is performed to remove ischemic, infected, necrotic tissue or locally unresectable tumor, and at times, is a life-saving procedure. Peripheral artery disease, alone or in combination with diabetes mellitus, contributes more than half of all amputations; trauma is the second leading cause. Lower extremity amputations are common debilitating complications in patients with diabetes mellitus. Our aim was to analyse the various causes for lower extremity amputations, assess the complications and amputation rates in patients with diabetes mellitus and to identify risk groups for lower extremity amputations that can be focussed for preventive treatment at Vydehi Institute of Medical Sciences and research centre, Bangalore. This retrospective audit was conducted jointly in the Dept of General Surgery &Dept of Medicine, VIMS&RC, a super speciality teaching hospital in south India, between Jan 2011 and Dec 2014. Case files of patients who underwent lower extremity amputations were retrieved from the institution medical records section and data analysed for demography, clinical presentation of diabetics, other causes for amputation such as vascular disorders, kidney disorders, malignancy and diabetic ulcer/ infections of the foot, and post-operative morbidity and mortality. 137 patients were amputated, of which 120(87.59%) males and 17(12.40%) females (table-1, fig-1). 82(59.85%) patients were diabetic and 55(40.14%) non diabetic patients which included twenty three peripheral vascular disease (16.78%), osteosarcoma 16(11.67%),crush injuries 9(6.56%) and elephantiasis 3(2.18%) (fig-3). Of the 82 diabetics males were 65(79.26%) and females 17(20.73%) (Table-2). Foot infections and chronic renal disease preceded amputation in patients with diabetes. Diabetic women were older than the men when amputated, diabetic men underwent multiple amputations both minor and major, had severe foot infections compared to the women. 90 % of all diabetes-related amputations were preceded by foot ulcers leading to ischaemic gangrene. Various interventions the patient underwent ranged from wound debridement to revision amputation ( table-3,fig-4)The number of diabetics attending the diabetic foot clinic increased over the years showing the impact of awareness programmers and counselling about the disease (fig-2).The complications of diabetic foot infections ranged from cellulitis to gangrene (table-4,fig-5) There was 50% reduction in the rate of amputations performed above the ankle in patients with diabetes during the year 2014( table-6)) as most of them were referred to the multidisciplinary foot team in our diabetic clinic prior to the decision of amputation. There was no mortality in the study. The gradual decrease in rate of major amputations is due to an active implementation of the consensus guidelines of foot care in the diabetic clinic and awareness of the patients to get themselves examined and treated for foot problems early. Diabetic foot complications and diabetic nephropathy when identified early in diabetics can prevent major lower extremity amputations. Keywords: Lower extremity amputations; Diabetic Foot ulcer; Diabetic foot complications.

Authors and Affiliations

Kumar Srinivasan, Ambikavathy M

Keywords

Lower extremity amputations; Diabetic Foot ulcer; Diabetic foot complications.

EP ID EP399574
DOI -
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