Reducing major lower extremity amputations after the introduction of a multidisciplinary team in patient with diabetes foot ulcer

Abstract

BackgroundDiabetic foot ulceration is receiving more attention because of its high amputation and mortality rate. It is essential to establish the frequency of amputations in people with diabetes after any change to the management of diabetic foot care. The present study aim to compare the frequency of lower-extremity amputations in patients with diabetes foot ulcer over a ten-year period.MethodsSix hundred forty eight patients with diabetes foot ulcer were retrospectively studied from 2004 to 2013. The clinical features, laboratory results and the lower-extremity amputations were recorded. Major amputation was defined as amputations above the ankle while minor amputation was amputations below the ankle in the present study.ResultsPatients with diabetic foot ulcer were old (age 66.96 ± 11.96 years), with a long duration of diabetes (10.30 ± 6.94 years), high HbA1c (9.19 ± 2.62 %), SBP (144.05 ± 24.18 mmHg), DBP (79.53 ± 11.88 mmHg), LDL-C (2.71 ± 0.93 mmol/L) and had great frequency of neuropathy (62.7 %), retinopathy (45.0 %), nephropathy (39.5 %) and PAD (33.2 %). From 2004 to 2013, the frequency of all lower-extremity amputations is 12.0 % (5.2 % major amputation, 6.8 % minor amputation). The frequency of major amputations decreased from 9.5 % in 2004 and 14.5 % in 2005 to less than 5.0 % after 2006. In particular, there was a significant decline in major amputations of diabetic foot patient with Wagner 3 to 4 wounds. The frequency rate of major amputations in diabetic foot patient with Wagner 3 to 4 wounds fell from 35.7 % in 2004 to 4.4 % after 2007. The change in frequency of minor amputations was fluctuation.ConclusionThis study demonstrates that the introduction of a multidisciplinary team, coordinated by an endocrinologist and a podiatrist, for managing diabetic foot disease is associated with a reduction in the frequency of major amputations in patients with diabetes.

Update on management of diabetic foot ulcers

“…9,15,27 Numerous studies and systematic reviews have showed positive effects on multidisciplinary care in reducing wound healing times, amputation rates, and severity of amputation. [28][29][30][31] The definition of multidisciplinary diabetic foot care varies broadly in the literature but often includes a surgeon (general, vascular, and orthopedic), podiatrist, diabetes specialist, physical therapist, and wound care nurse.…”

Outcome predictors for wound healing in patients with a diabetic foot ulcer

“…Identification of these high‐risk patients might lead to better and earlier treatment and targeted secondary prevention strategies. A treatment strategy to improve clinical outcome of DFU patients might be the introduction of a multidisciplinary team . It has been shown that the introduction of such a team to DFU care enables to reduce the frequency of major amputations .…”

Diabetic foot infection: Antibiotic therapy and good practice recommendations

“…Sharp debridement of ulcers, combined with pressure offloading, management of infection and the involvement of a multidisciplinary team to optimise glycaemia, cardiovascular risk, assess potential revascularisation and surgical intervention are considered to be the basis of ulcer care . In order to promote wound healing and reduce risk of amputation, involvement of the multidisciplinary team is recommended early in the natural history of the ulcer …”