Abstract

ABSTRACT
a. Objective: To determine frequency of Wagner’s grades in diabetic patients undergoing lower extremity amputations.
b. Methodology: It was a descriptive study conducted at the department of Surgery, PAF Hospital Mushaf, Sargodha, Pakistan and the time period was 6 months. During this period 220 patients with diabetic foot (who were admitted in surgical ward) aged 35 to 95 were included. Glycemic control was noted on the basis of fasting plasma glucose (FPG) and HbA1C. Patients were classified according to Wagner’s classification on the basis of clinical examination, X-rays findings (include pathological fracture and bone erosion) and culture sensitivity. Patients were categorized in 5 grades according to Wagner’s classification and types of amputations were noted.
c. Results: Out of 220 patients included in the study 168 (76.4%) were males and 52 (23.6%) were females. The mean age was 55.15 years. All of the patients were having diabetes (both IDDM and NIDDM). Glycemic control was poor in almost all of the patients with mean FPG of 18.2 mmol/l and mean HbA1C of 10.44%. 103 (46.8%) patients were having positive X-rays findings (bone fractures and erosions). 152 (69.1%) patients had positive cultures, most common organism was staphylococcus aureus. Frequency of Wagner’s grades undergoing amputations included 0 patients (0%) in Grade-1, 48 patients (21.8%) in grade-2, 80 patients (36.4%) in grade 3, 64 patients (29.1%) in grade-4, and 28 patients (12.7%) in grade-5. Treatment offered included ray amputation 57 (25.9%), trans-metatarsal amputation 53 (24.1%), below knee amputation (BKA) 60 (27.3%), above knee amputations (AKA) 3 (1.4%), rest of the patients underwent debridement 47 (21.4%).
d. Conclusion: Wagner’s classification helps grading diabetic foot ulcers effects and predict outcome, however amputation rates varies with grades. A total of 78.6% patients underwent amputation among patients admitted with diabetic foot ulcer in our surgical ward. Most frequent grades underwent amputations were grade-3 and grade-4.

Key words: Wagner’s classification, diabetes mellitus, amputation.