To determine the outcome of conservative management of diabetic foot as limb salvage.
Patients and Methods
This descriptive prospective study was conducted in the department of General and Orthopedic surgery, Ghulam Mohammad Mahar Medical Collage Hospital, Sukkur, Pakistan from January 2010 to December 2011. Sixty five patients with diabetic foot were included in the study. The treatment regimens consisted of conservative debridement or surgery, two to four weeks of i/v and oral antibiotics and multiple aseptic dressing. All the patients were assessed by the wagner’s grading system of diabetic foot and the most common grade of diabetic foot in this study were grade ii and iii. Follow up after hospital discharge was 6-12 months. Failure of conservative treatment was the main outcome measure.
A total of 65 diabetic patients were admitted for foot lesions with contiguous osteomyelitis, deep tissue involvement and/or gangrenous lesions. There were 47 (72.3%) male and 18 (27.69%) female patients, with male to female ratio of 3:1. Age ranged from 30 to 70 years (average 52). Initial conservative procedures were wound debridement (41patients), excision of necrotic bone (03 patients), small and /or big toe amputation (15 patients) and below and above knee amputations (6 patients) after failure of initial debridement. Conservative treatment was successful for 59 (90.76%) patients and six (9.23%) patients underwent major amputation after failure of conservative measures .There was 1.5% mortality.
It is concluded that conservative surgical intervention, long term empiric antibiotics and interdisciplinary wound care is a safe and effective alternative to amputation in selected patients. (Rawal Med J 2012;37:301-304).
Key words: Diabetic foot , Limb salvage, amputations