INTRODUCTION:
Diabetes continues to be one of the most common underlying factors associated with lower extremity amputation in post industrialized and developing countries. Amputations are perhaps the most feared but ignored complication of Diabetes by the innocent general public.
For most patients, amputation is a pivotal event that alters their quality and duration of life and strain on heart, when amputated patients uses crutches or artificial limb. Amputations have been associated with an increased risk of reamputation of the same extremity, amputation of the contralateral leg, an elevated mortality in the first 3 – 5 years after amputation and placement in nursing homes or extended care facilities.
There are several well accepted predisposing factors that place patients with diabetes with a high risk for a lower extremity amputation. The most common components in the causal pathway to limb loss Include peripheral neuropathy, peripheral vascular disease, ulceration and infection. Ulceration that is unattended is the most common single precursor to amputation and has been identified as a component in 85% of lower extremity amputations.
As diabetic foot problems quickly reach the point of no return, it is vital to diagnose them early and provide rapid and intensive treatment.
Furthermore, it is important to achieve early recognition of the at-risk foot so as to institute prompt preventive measures. The multidisciplinary foot clinic can reduce the numbers of amputations and enable us to take a new approach to the diabetic foot by early diagnosis and treatment.
Systematically recording the characteristics of ulcerations is critical to planning treatment strategies, monitoring treatment effectiveness, predicting clinical outcomes and improving communication among health care providers.
Most classification systems reported in the medical literature have primarily focused on the depth of the ulceration and have neglected or inconsistently included infection, peripheral neuropathy, peripheral vascular disease and previous amputation. These factors have been widely discussed in the literature. The aim of this study was to study the prevalence of the risk factors like, peripheral neuropathy and peripheral vascular disease among thousand cases admitted to hospital and their influence in deciding the final outcome of the patient. Also the prevalence of amputation at different levels is studied.
AIM OF THE STUDY:
1. To study the outcome of 1000 cases of diabetic foot with respect to primary healing and amputation.
2. To study the prevalence of diabetic foot in patients admitted to GRH with regard to age, sex distribution.
3. To study the prevalence of peripheral neuropathy and peripheral vascular disease.
4. To study the amputation among these patients with regard to its incidence and level of amputation.
MATERIALS AND METHODS:
This study was conducted in Government Rajaji Hospital, Madurai from July 2007 to August 2009 and included 1000 cases admitted in surgical ward. Patients treated as OP are excluded from the study. As part of the protocol patients treated in the ward have a standardized evaluation to assess peripheral neuropathy and peripheral vascular disease. The diagnosis of diabetes was verified for all patients using the criteria set forth by the World Health Organization, which include treatment with insulin, two random glucose measurements >200 mg/dl or a fasting glucose >126 mg/dl.
Sensory neuropathy was evaluated with a 10-g Semmes –Weinstein monofilament wire and a modified neuropathy disability score. The diagnosis of infection was made using clinical criteria. Wounds with frank purulence and/ or two or more of the following local signs were classified as “infected”. These signs include warmth, erythema, lymphangitis, lymphadenopathy, edema, pain and loss of function.
CONCLUSION:
In our study, Diabetic foot ulcer was more common in males (61.4 %). The most common affected age group was between 51 to 60 years in both males and females. Mean age of males is 59.5 years and females is 51.3 years. One- fourth of the patients had Peripheral Neuropathy. 30 % of Patients who presented with neuropathy were amputated at Trans metatarsal level or proximally and it was statistically significant.
• One- fifth of the patients had Peripheral Vascular Disease with a significant male preponderance. 31.3 % of patients who presented with ischemia were amputated at Trans metatarsal level or proximally and it was statistically significant.
• Amputation rates was 15.4% among diabetic foot patients with a significant Male preponderance. Distal amputations was more commoner than Proximal amputations.
• Thus Peripheral Neuropathy and Peripheral Vascular Disease play a definite role in the outcome of the wound and it can be detected by simple examination and non invasive test.
• Awareness of Diabetic foot complications has to be increased among the Diabetic patients and their relatives by educating them, since the outcome was very good in early diagnosis of Diabetic foot.
• All newly diagnosed Diabetics, must be evaluated for Diabetic foot and foot care has to be given routinely to prevent the Diabetic foot complications at latter date
