DIABETIC PATIENT

LOWER EXTREMITY AMPUTATION

Abstract

Introduction: Limb loss is most feared complication of diabetes. The statistics associated with
amputation create a very real concern. Fifty percent of all non-traumatic amputations occur in the diabetic patient. The
risk of a leg amputation is 15 to 40 times greater for a person with diabetes. Each year, six of every thousand diabetic
individuals undergo surgery for an amputation. Objectives: To evaluate the frequency of lower limb amputations in
diabetic patients, hence emphasizing the importance of timely surgical intervention in salvage of lower limb and to
reduce the morbidity and mortality. Study design Descriptive study. Setting: Surgical OPD, Causality Ward and
Medical Unit, Nishtar Hospital Multan. Duration: One year. Material and methods: 100 patients. Results: The
incidence of amputations rose steeply with age; most amputation occurred in patients over 60 year. The incidence was
a higher in men than in women. The incidences of major amputations were 32% than that of minor amputations. Nearly
40% of all subjects under going afoot level amputation had a previous history of foot amputation. However nearly 40%
of all subjects under going a foot level amputation had not been diagnosed either before or during admission with
peripheral arterial occlusive disease, suggesting a casual pathway dependent primarily on neuropathy. The main out
come variables were the number of repeat operations and hospitalization for salvage of limb with recurrent or persistent
infection, and time to complete forefoot healing or foot amputation Conclusions: Amputations performed at healthy
zones reduce the hospital stay of the patient but mortality was more consistently for proximal amputations. Better
screening of diabetic patients with appropriate risk directed treatment at primary care level might significantly impact
the large number of preventable diabetes related lower extremity amputations.