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A clinical study of diabetic foot patients who underwent amputations in a tertiary care center—an observational study

Sachin Suryawanshi, Rajesh Kumar Mahey, Nilesh Bakale, Ajay Alva.

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Introduction: Amputation in diabetic foot patients, though lifesaving, has a negative impact on a patient’s quality of life. This study aimed to identify various clinical presentations and risk factors associated with amputation in diabetic foot patients. Methods: This prospective observational study was conducted at a tertiary care center for one year, from August 2013 to July 2014. In total, 60 patients with diabetic foot ulcers admitted and operated on for amputation were included. A detailed history and clinical examination were performed. Routine blood examination, wound swab for culture and antibiotic sensitivity, and appropriate radiological examination were performed, and the grading of diabetic foot wounds was done using Wagner’s classification. The above data was recorded and analyzed. Results: The most common age group was 50–59 years (34%), with a mean age of presentation of 56.31 years. Males were more predominantly affected than females, with a male-to-female ratio of 2:1. Gangrene was the commonest mode of presentation (67%), followed by an ulcer (20%). Most patients (45%) underwent Ray’s amputation, followed by trans-metatarsal (34%), and 21% required a higher level of amputation. Most amputations were noted in patients with a combination of risk factors (76.5%) such as sepsis, poor glycemic control, ischemia, neuropathy, and osteomyelitis, as compared to patients with solitary risk factors (23.5%). Conclusion: Gangrene was a common clinical presentation in a patient with a diabetic foot undergoing amputation. The highest incidence of amputation was observed in patients with multiple risk factors such as sepsis, poor glycemic control, ischemia, neuropathy, and osteomyelitis compared to patients with a solitary risk factor. This factor acts synergistically and concurrently, rather than independently and sequentially.

Key words: Diabetic foot ulcer, amputation, risk factors

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