Bruttocao, A

Gruppo, M

Lorenzetti, R

Martella, B

Mazzalai, F

Militello, C

Nistri, R

Spirch, S

Terranova, C

English

PubMed

Lorenzetti R

Mazzalai F

Gruppo M

Nistri R

Spirch S

Martella B

Terranova C

Bruttocao A

Militello C

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BMC Geriatrics

Surgery of diabetic foot in the elderly: early Vs deferred treatment

A Bruttocao

C Terranova

B Martella

S Spirch

R Nistri

M Gruppo

F Mazzalai

R Lorenzetti

C Militello

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MEETING ABSTRACT Open Access
Surgery of diabetic foot in the elderly:
early Vs deferred treatment
A Bruttocao1*, C Terranova2, B Martella1, S Spirch1, R Nistri1, M Gruppo1, F Mazzalai1, R Lorenzetti1, C Militello1
From de Senectute: Age and Health Forum
Catanzaro, Italy. 5-7 December 2009
Background
In 1996, the overall prevalence of diabetic patients was
120 million and it will more than double by the year
2025.
The most important complication in these patients is
the diabetic foot (sepsis, abscess etc.).
The aim of this study was to assess the role and
results of surgery, performed in emergency or deferred
emergency, in older population affected by acute septic
foot.
Materials and methods
From 01.01.2004 to 31.12.2008, 100 patients (average
age 74.5 ± 7.3) affected by insulin dependent diabetes
complicated by sepsis and abscess of the lower limb
were treated in emergency surgery. The inclusion of
subjects in the study was considered ethically correct
assessment by medical examiner.
61 patients were submitted after a visit to immediate
surgical drainage and toilets (group A), while 59 patients
were transferred from other departments after an aver-
age stay of 6.9 ± 3.6 days during which only conserva-
tive therapy had been implemented (group B).
Results
No differences were found between the 2 groups regard-
ing age and clinical features (general conditions, conco-
mitant diseases etc.), except for the following differences
in Group B: higher levels of glucose in the blood
(P = 0.015), lower levels of albumin (P = 0.005), and
more frequent extension of inflammatory processes to
proximal regions of leg (P = 0.005).
The resolution was achieved in group A, without
amputation in 13 patients, with amputation of 1 or
more toes in 28, with metatarsal amputation in 18 and
with Chopart amputation in 2 cases.
Group B: incision and drainage were sufficient only in
4 patients, amputation of 1 or more toes in 21, minor
amputations (metatarsal) in 10, Chopart amputations in
20 patients and mayor amputations (leg) in 4 cases.
The level of amputation was significantly more proxi-
mal in group B (Chi2 = 24.3 P < 0.001).
The logistic regression analysis showed a significant
relationship between the level of amputation and the
number of days elapsed before debridement (odds ratio,
1.61; P = 0.015; confidence interval, 1.10–2.36), but not
in the presence of peripheral occlusive disease (odds
ratio, 1.72, P = 0.376; confidence interval, 0.28–15.2).
Conclusions
In elderly patients with a diabetic foot, the function of
the lower limbs is significantly reduced in the case of
delayed surgical debridment because of the inflamma-
tory process.
Author details
1Clinic of Geriatric Surgery, Hospital University of Padua, Italy. 2Unit of
Forensic Toxicology and Antidoping, Hospital University of Padua, Italy.
Published: 19 May 2010
doi:10.1186/1471-2318-10-S1-A46
Cite this article as: Bruttocao et al.: Surgery of diabetic foot in the
elderly: early Vs deferred treatment. BMC Geriatrics 2010 10(Suppl 1):A46.
1Clinic of Geriatric Surgery, Hospital University of Padua, Italy
Bruttocao et al. BMC Geriatrics 2010, 10(Suppl 1):A46
http://www.biomedcentral.com/1471-2318/10/S1/A46
© 2010 Bruttocao et al; licensee BioMed Central Ltd.


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Surgery of diabetic foot in the elderly: early Vs deferred treatment

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