Revascularization Gaps in Diabetic Foot Disease in Nigeria: Health-System Constraints and the Need for a National Limb-Salvage Strategy.

Abstract

Background: Diabetic foot ulceration remains a major cause of non-traumatic lower-limb amputation, disability, prolonged hospitalisation and excess mortality. Nigerian studies document substantial burdens of ulceration, late presentation and amputation, but national data on vascular assessment, referral and revascularization remain limited.

Methodology: PubMed/MEDLINE, Google Scholar and African Journals Online, together with relevant guideline, epidemiology, health-financing and programme websites, were searched from inception to 15 July 2026. Approximately 250 potentially relevant records were identified; about 74 full-text articles, guidelines and policy documents were assessed, and 36 sources were retained for thematic synthesis. Nigerian evidence was prioritised. Selection considered direct relevance, methodological clarity and contribution to prespecified clinical and health-system themes; no formal risk-of-bias instrument or meta-analysis was used.

Results: The available literature is consistent with a probable, but currently unquantified, revascularization gap within Nigerian diabetic-foot services. Potential contributors include delayed recognition of peripheral arterial disease (PAD), inconsistent objective perfusion assessment, scarce and geographically concentrated vascular expertise, limited imaging and procedural infrastructure, fragmented referral pathways and high out-of-pocket costs. Revascularization remains the central focus of this review because restoration of perfusion is indispensable when ischaemia threatens healing; however, it is one component of comprehensive multidisciplinary care in diabetic foot disease.

Conclusion: Nigeria should strengthen objective vascular assessment and timely access to revascularization within an integrated limb-salvage pathway that also prioritises infection control, offloading, glycaemic and cardiovascular risk optimisation, wound care, nutrition, smoking cessation and rehabilitation. National data systems are needed to quantify service gaps and evaluate outcomes.