RISK FACTORS LEADING TO MAJOR LOWER LIMB AMPUTATIONS IN DIABETIC PATIENTS WITH FOOT ULCERS

Abstract

Purpose: Foot ulceration in persons with diabetes is the most frequent precursor to amputation, which impairs their activities. The aim of this study was to describe factors that lead to amputation of a diabetic foot, and propose a management strategy to prevent major amputation. Methods: Cross-sectional study was conducted at the Qazi Hussain Ahmad Hosptial, Nowshera Pakistan, from Jan, 2016, July 2021, and comprised patients of either gender having type 1 or type 2 diabetes and foot ulcers. The wounds were assessed according to Wagner wound staging and wound sepsis was evaluated in terms of local infection of the wound, leukocytosis and osteomyelitis of the bone. The glycemic control of these patients was assessed on presentation by measuring glaciated hemoglobin levels. Data was analyzed using SPSS 22. Findings: Out Of the 450 patients, 263(60%) were males and 187(40%) were females. Majority patients 193(43%) were aged 40-70 years. All 450(100%) patients underwent some type of amputation. Of all the amputations, 301(67%) were done in patients with poor glycaemic control on presentation, and 187(41%) in those with stage 4 wound. Local wound infection, increased total leukocyte count and bone showing features of osteomyelitis were significantly associated with increased risk of lower extremity amputations (p<0.05). Conclusion: With the proper glycemic control and early presentation and treatment, majority of amputations could be avoided in diabetic patients with foot ulcers.