Characteristics and management of patients undergoing emergency surgery for diabetic foot attack

Abstract

BACKGROUND: Diabetic foot attack (DFA) is considered one of the worst manifestations of diabetic foot. It is necessary to act quickly to prevent amputation and save the patient’s life. The aim of this study is to reveal the characteristic features of DFAs and be a guide to healthcare professionals to manage and refer these patients. METHODS: Sixty-five patients with DFAs were analyzed retrospectively. Demographics were collected. All patients’ infectious diseases Society of America/International Working Group on the Diabetic Foot (IDSA/IWDGF) stages, ischemia site neuropathy, bacterial infection and depth (SINBAD) and laboratory risk indicator for necrotizing fasciitis (LRINEC) scores were calculated. According to these measurements, patients were categorized and statistical results were obtained. RESULTS: We found that patients who underwent emergency surgery due to DFA applied to an average of two hospitals before applying to our facility and the median acceptance time since the beginning of the first complaint was 9 days. All patients were IDSA/IWDGF stages three and four. Most of the patients had SINBAD scores between four and six. 60% of the patients were at high risk for necrotizing fasciitis according to the LRINEC score. 58.2% of patients had periferic arterial stenosis and the amputation rate was 69.2%. In the intensive care unit, 21.3% of the patients were followed in the intensive care unit, and our patients’ mortality rate was 4.2%. CONCLUSION: DFA is an emergency surgical condition that requires high clinical suspicion. If not diagnosed and treated with emergency surgery, it has a high mortality and amputation rate. High white blood cell count in patients, local and systemic signs of inflammation, presence of subcutaneous emphysema in the lower extremities on a direct X-ray radiography, and high blood sugar should be considered as warning signs for DFA. Emergency surgical intervention should be performed on these patients, and if the patient is not in a suitable center for emergency surgery, they should be rapidly referred to a center with experienced clinicians.