A trial of conservative amputations for lesions of the feet in diabetes mellitus

Baddeley, R. M.; Fulford, Jonathan

doi:10.1002/bjs.1800520109

Cited by 38 publications

(13 citation statements)

References 12 publications

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“…If gangrene or diabetes were present the chances of success were smaller still and an above-knee amputation was the procedure of choice. There is no doubt that above-knee amputations heal well; Baddeley and Fulford (1965) had no failures in 28 cases. There is much to be said for an amputation which invariably heals by first intention, as an amputation often comes at the end of a long series of failed arterial procedures, and to have to re-amputate under these conditions is demoralizing for the patient and may well be fatal (Lemke, King, Kaiser, Judd, and Narhwold, 1963;Bradham and Smoak, 196 5).…”

Section: Below-and Through-knee Amputations Inmentioning

confidence: 98%

Below- and through-knee amputations in ischaemic disease

Chilvers¹,

Briggs²,

Browse³

et al. 1971

Journal of British Surgery

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Fifty‐three below‐knee amputations and 22 through‐knee amputations were done for ischaemic disease at St. Thomas's Hospital over the past 5 years. It was found that 36 of the below‐knee amputations healed satisfactorily, 27 by first intention, 9 after infection. Eleven of the through‐knee amputations healed, 4 after infection. The healing was unaffected by the presence or absence of peripheral gangrene. It is suggested that is suggested that in ischaemic disease of the lower limbs a below‐knee amputation should be considered as it has a 70 per cent chance of healing, but if it is felt that this amputation is not suitable then an above‐knee amputation should be done in preference to a through‐knee amputation.

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Section: Below-and Through-knee Amputations Inmentioning

confidence: 98%

Below- and through-knee amputations in ischaemic disease

Chilvers¹,

Briggs²,

Browse³

et al. 1971

Journal of British Surgery

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“…Bodily and Burgess (10) studied the reamputation rate of patients with a major amputation from critical limb ischemia and found that 8 of 22 diabetic patients had a reamputation (36.3%) to their contralateral limb at 2-year follow-up. Reported rates of contralateral reamputations vary at years 3 (23-30%) and 5 (28 -51%) (8,9).…”

Section: Rate Of Reamputation On Contralateral Limb By Original Amputmentioning

confidence: 99%

“…It has been shown that a history of ulceration increases the risk of amputation (3,4), as do prior amputations (4). Several studies have reported reamputation rates (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). However, the results of these studies are too general to apply to individual patients; some studies combined reamputation episodes of both ipsilateral and contralateral limbs (5-7) and others addressed reamputation of only one extremity (8 -10).…”

mentioning

confidence: 99%

Risk of Reamputation in Diabetic Patients Stratified by Limb and Level of Amputation

et al. 2006

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OBJECTIVE -This study examined the risk of reamputation, stratified by original level of amputation, in a population of diabetic patients. We also illustrated reamputation rates by ipsilateral and contralateral limbs.RESEARCH DESIGN AND METHODS -The study population included 277 diabetic patients with a first lower-extremity amputation performed between 1993 and 1997 at University Hospital in San Antonio, Texas. Reamputation episodes for the ipsilateral and contralateral limbs were recorded through 2003. Using a cumulative incidence curve analysis, we compared the reamputation rate by limb. Cumulative rates of reamputation were calculated for each limb at each amputation level at 1, 3, and 5 years.RESULTS -Cumulative rates of reamputation per person were 26.7% at 1 year, 48.3% at 3 years, and 60.7% at 5 years. Ipsilateral reamputation per amputation level at the 1-, 3-, and 5-year points were toe: 22.8, 39.6, and 52.3%; ray: 28.7, 41.2, and 50%; midfoot: 18.8, 33.3, and 42.9%; and major: 4.7, 11.8, and 13.3%. For contralateral reamputation, the rates at 1, 3, and 5 years were toe: 3.5, 18.8, and 29.5%; ray: 9.3, 21.6, and 29.2%; midfoot: 9.4, 18.5, and 33.3%; and major: 11.6, 44.1, and 53.3%.CONCLUSIONS -This study showed that a patient is at greatest risk for further same-limb amputation in the 6 months after the initial amputation. Although risk to the contralateral limb rises steadily, it never meets the level of that of the ipsilateral limb. This finding will help clinicians focus preventive efforts and medical resources during individualized at-risk periods for diabetic patients undergoing first-time amputations. Diabetes Care 29:566 -570, 2006F oot ulcers and lower-extremity amputations (LEAs) are disabling complications of diabetes that can lead to significant increases in mortality and morbidity (1,2), most notably recurrent amputation at increasingly higher levels. It has been shown that a history of ulceration increases the risk of amputation (3,4), as do prior amputations (4). Several studies have reported reamputation rates (5-15). However, the results of these studies are too general to apply to individual patients; some studies combined reamputation episodes of both ipsilateral and contralateral limbs (5-7) and others addressed reamputation of only one extremity (8 -10). Reamputations at specific levels have been studied (11-15), but how the rates differ by level of amputation is still unknown. In addition, many of these studies included reamputations for patients with existing amputations. The true reamputation rate of first-time amputations has not been reported before this study.In this retrospective cohort study, we aimed to 1) illustrate the difference between the reamputation risk for ipsilateral and contralateral limbs and 2) stratify the risk of reamputation by the original level of amputation. With these findings, we hope to help clinicians estimate individualized risk for patients based on the level of first-time amputation.RESEARCH DESIGN AND METHODS -In this retrospective cohort study,...

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“…Contralateral complications are common in people in remission from previous diabetic foot complications 24–31. In fact, more than 25% of all LEAs are re-amputations 45.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, many at-risk patients are unable to measure temperatures on both feet due to history of high-level amputation or due to ongoing treatment of an unhealed wound which necessitates dressings, casting, or other therapeutic footwear that should not be removed. Additionally, patients who have suffered LEA are at high risk for complications to the contralateral foot 24–31. These studies show that as many as 55% of patients with a history of LEA suffer subsequent amputation of the contralateral limb within 5 years.…”

Section: Introductionmentioning

confidence: 93%

Unilateral remote temperature monitoring to predict future ulceration for the diabetic foot in remission

Lavery

Petersen

Linders

et al. 2019

BMJ Open Diab Res Care

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ObjectiveDaily remote foot temperature monitoring is an evidence-based preventive practice for patients at risk for diabetic foot complications. Unfortunately, the conventional approach requires comparison of temperatures between contralaterally matched anatomy, limiting practice in high-risk cohorts such as patients with a wound to one foot and those with proximal lower extremity amputation (LEA). We developed and assessed a novel approach for monitoring of a single foot for the prevention and early detection of diabetic foot complications. The purpose of this study was to assess the sensitivity, specificity, and lead time associated with unilateral diabetic foot temperature monitoring.Research design and methodsWe used comparisons among ipsilateral foot temperatures and between foot temperatures and ambient temperature as a marker of inflammation. We analyzed data collected from a 129-participant longitudinal study to evaluate the predictive accuracy of our approach. To evaluate classification accuracy, we constructed a receiver operator characteristic curve and reported sensitivity, specificity, and lead time for four different monitoring settings.ResultsUsing this approach, monitoring a single foot was found to predict 91% of impending non-acute plantar foot ulcers on average 41 days before clinical presentation with a resultant mean 4.2 alerts per participant-year. By adjusting the threshold temperature setting, the specificity could be increased to 78% with corresponding reduced sensitivity of 53%, lead time of 33 days, and 2.2 alerts per participant-year.ConclusionsGiven the high incidence of subsequent diabetic foot complications to the sound foot in patients with a history of proximal LEA and patients being treated for a wound, practice of daily temperature monitoring of a single foot has the potential to significantly improve outcomes and reduce resource utilization in this challenging high-risk population.

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A trial of conservative amputations for lesions of the feet in diabetes mellitus

Cited by 38 publications

References 12 publications

Below- and through-knee amputations in ischaemic disease

Below- and through-knee amputations in ischaemic disease

Risk of Reamputation in Diabetic Patients Stratified by Limb and Level of Amputation

Unilateral remote temperature monitoring to predict future ulceration for the diabetic foot in remission

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