Ramkumar, R R (2006) Diabetic Foot Ulcers. Masters thesis, Thanjavur Medical College, Thanjavur.
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Abstract
INTRODUCTION: For the past few decades there has been an alarming rise in the prevalence of diabetes particularly type II DM. This correlates with the rising rates of obesity. In the diabetic population, foot complications are a major cause of hospitalization. 20% of diabetics develop some foot problems during the course of their illness. The foot ulcers are characterized by an inability to self-repair in a timely and orderly manner. Risk factors for Diabetic foot ulcer are: i. Long Diabetes duration. ii. Peripheral neuropathy. iii. Peripheral vascular disease. iv. Prior foot ulcers. v. Prior amputations. The prevalence of neuropathy in diabetics is 23%. The prevalence of peripheral vascular disease is 15%. About 50% of the diabetic foot ulcers require a minor or major lower limb amputation. About 45% of all lower limb amputations are performed for Diabetic foot disease. Foot ulcers result in amputations in about 50% of patients. Once one limb has been amputated, the patient’s 5-year survival rate is only about 30%. Thus the morbidity extracts a considerable toll not only on health care provision but especially on patients. We should strongly endorse a national initiative, which should parallel the advances and understanding of the pathophysiology and treatment so as to create diabetic foot clinics to combat this challenge. AIM OF THE STUDY: 1. To study the percentage of patients undergoing amputation for diabetic ulcer of foot. 2. To study the percentage of biopsy proved neuropathic changes in diabetic foot ulcer. 3. To study the common organisms causing foot infection and the sensitivity of the drug in patients with diabetic foot ulcer. 4. To study the percentage of vascular changes in diabetic foot ulcer. 5. To study the number of patients showing osteomyelitis in Roentgenogram. MATERIALS AND METHODS: The clinical material for this study consisted of 50 cases of Diabetic foot ulcer patients admitted in the surgical wards of Thanjavur Medical College Hospital, Thanjavur during the period 2003 to 2006. The patients were selected based on the following criteria. 1. Presence of Diabetes mellitus. 2. Patients with major trauma as a cause of foot ulcer are excluded. 2. Thermal burns or scalds are excluded. 3. Patients with Hansen’s disease leading to trophic ulcer are excluded. 4. Patients with filariasis and its sequelae are excluded. The following data were collected and recorded. In the proforma, name and age of the patient, sex, occupation, complaints and history in detail were obtained and recorded. Past history of diabetes, hypertension, tuberculosis and ischemic heart disease were enquired into. Smoking and alcohol history were elicited with special reference. Patients were examined in detail about the general condition like anemia, jaundice, fever, blood pressure and peripheral pulses. The affected part of the foot the ulcer was examined in detail for all the features of an ulcer with special reference to motor and sensory changes. CONCLUSION: The epidemiology of this study revealed that the patients with diabetic foot ulcers constitute 0.2% of inpatients per year. Diabetic foot ulcer is the commonest cause of foot ulcers in Thanjavur Medical College Hospital, Thanjavur. In this study, the incidence of Diabetic foot ulcers increased with age, which correlates with the literature. In this study, the predominant affected sex were males, with male:female ratio of 4:1 which contradicts the western study where the affected gender is commonly female with male : female ratio of 1 : 2.5. Pus culture and sensitivity done for diabetic foot ulcers reveal E.coli as the commonest organism (40%) when compared to standard study which mention mixed infection – staphyloccus and proteus as the commonest organisms. Skin biopsy done in these patients reveal neuropathic changes in 34 patients. This result is comparable with the standard study. 46% of patients had vaso-occlusive disease which is slightly higher compared to the western study which states the prevalence of vaso-occlusive disease as 30%. But this series is too small to comment. 3 out of 50 patients showed osteomyelitic changes emphasizing that diabetic ulcer patients are prone for osteomyelitis of the underlying bone. 46% of patients with diabetic foot ulcer needed either minor or major amputation, which correlates with the standard study.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Diabetic Foot Ulcers. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Devi S |
| Date Deposited: | 14 May 2018 15:43 |
| Last Modified: | 14 May 2018 15:43 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7826 |
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