A study of Factors influencing major amputations in diabetic foot

Dinesh Kannan, G (2013) A study of Factors influencing major amputations in diabetic foot. Masters thesis, Madurai Medical College, Madurai.

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Abstract

INTRODUCTION: Diabetes is a common disease causing lower extremity amputation throughout the world, particularly in India, the Diabetic capital of the world. By 2025, it is estimated that India will have world’s majority of diabetics. Diabetes Mellitus is the most important cause of non-traumatic amputations worldwide. Amputations are perhaps the most feared complication of Diabetes. In 2011 around 8.3% of world population had diabetes. Among these, vast majority were inhabiting in developing nations. It is projected that by the year 2030, around 10% of the human race would become diabetics. The troublesome fact is that this disease is being diagnosed more and more in the younger population of the world. Each year, over one million amputations are being performed to alleviate disease caused by diabetes. This roughly works out as one amputation in the world every 30 seconds. The predisposing factors that lead to amputation are diabetic neuropathy, bony deformities, inconspicuous trauma, and vascular diseases. In the presence of an ulcer, local sepsis and vascular insufficiency are major causes of amputation. The presentation of lesions greatly differ based on socio-economic status, quality of foot care and usage of footwear. It has been projected that one in six diabetics living in developed nations will develop ulceration before they die. This problem is even more menacing in developing nations. Diabetic foot not only affects the individual but also their family and the community as a whole. It causes great strain on the financial and health care infra-structure of the nation. Another cause of concern is the emergence of type 2 Diabetes in children. These cases will eventually progress to develop micro and macrovascular complications including life-threatening infections at an early age. Around 25% of these cases will be non-healing and upto 28% will end up in amputation. Investing in a scientific foot care techniques and guidelines will be more cost effective in the long run. Amputations alter quality of life and longevity. Amputations are associated with an increased risk of re-amputation and at an increased mortality in first decade after amputation. Early diagnosis and prompt therapy is mandatory. A team approach can reduce the number of amputations. Adequate infra-structure and facilities are essential. However, ignorance on the part of the patients and also the health care provider has made this goal hard to attain. AIM OF STUDY: To determine the various factors that are influencing major amputation in Diabetic foot To emphasize the actions that are needed to prevent the progression of the disease. MATERIALS AND METHODS: This study was conducted in Government Rajaji Hospital, Madurai from January 2011 to December 2012 and included 81 cases both males and females, who have been amputated in surgical ward irrespective of the age group. The diagnosis of Diabetes was made by measuring random blood sugar value on admission. The following details were collected by a questionnaire. 1. Duration of Diabetes, 2. Previous history of minor amputation, 3. Whether the habit of smoking present or not, 4. Educational status, 5. Whether patient is using footwear or not, 6. Previous history of minor amputation present or not. Design of the Study: Descriptive Study. Period of Study: January 2011- December 2012. Selection of Subjects: Inclusion Criterion: All cases of diabetic foot undergoing major amputation at the Department of General Surgery, Govt. Rajaji Hospital, Madurai during the study period were included in the study. Major amputation is defined as below knee (transtibial) or higher levels of amputation. Exclusion Criterion: Patients with Diabetes Mellitus undergoing major amputation following trauma. Patients who had undergone prior major amputation with sepsis in the stump. Patients not willing to participate in the study. CONCLUSION: 1. The majority of the amputees in our study were males. The number of the cases being 48 males and 33 females. This workout to a preponderance ratio of 1.46: 1. 2. Amputations were more commonly done in the age group of 50 to 60 years. Rehabilitation of these patient subset proves to be a difficult task given the occurrence of numerous other comorbidities such as hypertension, coronary heart disease and neurological disorders etc. 3. There seems to be apparent reduction in the rate of amputation in the older age groups. This observation cannot be projected with certainty because of the fact that these older age group subjects do not present to the hospital in most cases, and also they are less prone to ulceration due to the generalized decrease in the ambulatory capacity. 4. Longer the patient with diabetes, the more chance of landing up with amputation. In our study , 45 out of 81 patients underwent major amputation , having diabetes for more than 10 years duration. 5. In our study, 36 out of 81 patients had previous history of minor amputations. 6. 65.4% of our study subjects who were infact using footwear, still ended up with ulcerations leading to major amputation. This is mostly due to lack of knowledge regarding proper and adequate foot care. 7. A vast majority of our study subjects had peripheral neuropathy (76.5%) as a risk factor for amputation, rather than chronic arterial insufficiency (54.3%). 8. 68 out of 81 cases had profound malnutrition, indicated by serum albumin level of less than 3 gms. Improvement of the nutritional status helps to overcome sepsis and promote wound healing. 9. Majority of the infections in diabetic ulcers were polymicrobial followed closely by the presence of Pseudomonas aeroginosa. 10. Osteomyelitis in a diabetic foot is very difficult to treat and frequently necessitates amputation. Among the study subjects 29 (35.8%) had evidence of osteomyelitis on imaging. Amputation often becomes a palliative or life saving procedure. Major amputations in the younger age group has devastating socioeconomic consequences. Advances in prosthesis and rehabilitation can lessen this burden. Still the most cost effective methods are directed at prevention.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Factors influencing ; major amputations ; diabetic foot.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 05 Jun 2018 01:43
Last Modified: 05 Jun 2018 02:25
URI: http://repository-tnmgrmu.ac.in/id/eprint/8194

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