Diabetic foot ulcer and its surgical management
Keywords:Amputations, Diabetic foot ulcer, Diabetes mellitus
Background: Almost 80% population of diabetic foot are from low to middle income countries like India, a country with second largest number of diabetic populations. Prevalence of diabetes mellitus in India is 9.3%. Lower extremity diseases, including peripheral neuropathy, peripheral arterial disease, and foot ulceration, is twice common in diabetic subjects. the most feared consequence of diabetic foot ulcer is limb amputation, which is seen 10 to 30 times more often in person with diabetes. The objective of this study concentrates on surgical management of diabetic foot ulcer.
Methods: This is an observational prospective study of 100 cases for evaluation of diabetic foot ulcer and its surgical management at P.D.U. Hospital, Rajkot from January 2017 to November 2018.
Results: The average age of presentation is 55.70 year. The male to female ratio was 1.27:1. Most of the patients are from lower middle class and upper lower class according to modified kuppuswamy socioeconomic classification. Most of the patients have duration of diabetes more than 5 years. Most common microorganism grown from culture was Staphylococcus aureus. This study has higher rate of amputations of 74% due to late presentation and neglected disease due to peripheral neuropathy causes decreased pain sensation. There was no mortality in this study.
Conclusions: Management of diabetic foot ulcer is by multimodal approach with conservative and surgical approaches. Preventive measures, early diagnosis and timely surgical intervention prevents limb amputations in diabetic foot ulcer.
Treves F. Treatment of perforating ulcer of the foot. Lancet. 1884;2:949.
Sanders LJ, Robbins JM, Edmonds ME: History of the team approach to amputation prevention: pioneers and milestones. J Vasc Surg. 2010;52:3S.
Faglia E, Dalla Paola L, Clerici G, Clerissi J, Graziani L, Fusaro M, et al. Peripheral angioplasty as the first-choice revascularization procedure in diabetic patients with critical limb ischemia: prospective study of 993 consecutive patients hospitalized and followed between 1999 and 2003. Eur J Vascular Endovas Surg. 2005 Jun 1;29(6):620-7.
Atlas D. International diabetes federation. IDF Diabetes Atlas, 7th Edn. Brussels, Belgium: International Diabetes Federation; 2015.
Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, et al. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: Phase I results of the Indian Council of Medical Research–INdia DIABetes (ICMR–INDIAB) study. Diabetologia. 2011 Dec 1;54(12):3022-7.
Armstrong DG, Wrobel J, Robbins JM. Guest Editorial: are diabetes‐related wounds and amputations worse than cancer?. Int Wound J. 2007 Dec;4(4):286-7.
Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005 Jan 12;293(2):217-28.
Mayfield JA, Reiber GE, Nelson RG, Greene T. A foot risk classification system to predict diabetic amputation in Pima Indians. Diab Care. 1996 Jul 1;19(7):704-9.
Khan AA, Singh S, Singh V, Khan S. Diabetic foot ulcer: a clinical study. Int Surg J. 2016 Dec 10;3(4):2098-103.
Gohel JB, Sharma D, Patel NB, Raswan US, Patil S. A study of socio demographic and clinical profile of cases of diabetic foot. IJMR 2012;2:279-81.
Ali SM, Basit A, Sheikh T, Mumtaz S, Hydrie MZ. Diabetic foot ulcer-A prospective study. J Pakistan Med Assoc. 2001 Feb;51(2):78-80.