Survival and associated risk factors in patients with diabetes and amputations caused by infectious foot gangrene

Abstract

BackgroundInfectious gangrene of the foot is a serious complication of diabetes that usually leads to a certain level of lower-extremity amputation (LEA). Nevertheless, the long-term survival and factors associated with mortality in such patients have yet to be elucidated.MethodsA total of 157 patients with type 2 diabetes who received treatment for infectious foot gangrene at a major diabetic foot center in Taiwan from 2002 to 2009 were enrolled, of whom 90 had major LEAs (above the ankle) and 67 had minor LEAs (below the ankle). Clinical data during treatment were used for the analysis of survival and LEA, and survival was tracked after treatment until December 2012.ResultsOf the 157 patients, 109 died, with a median survival time of 3.12 years and 5-year survival rate of 40%. Age [hazard ratio 1.04 (95% confidence interval 1.01–1.06)], and major LEA [1.80 (1.05–3.09)] were independent factors associated with mortality. Patients with minor LEAs had a better median survival than those with major LEAs (5.5 and 1.9 years, respectively, P < 0.01). An abnormal ankle-brachial index was an independent risk factor [odds ratio 3.12 (95% CI 1.18–8.24)] for a poor outcome (major LEA) after adjusting for age, smoking status, hypertension, major adverse cardiac events, and renal function.ConclusionsEfforts to limit amputations below the ankle resulted in better survival of patients with infectious foot gangrene. An abnormal ankle-brachial index may guide physicians to make appropriate decisions with regards to the amputation level.

Value of MRI in changing of diabetic foot osteomyelitis management

“…Also, the risk of recurrent infection is the highest for those patients with the most aggressive amputations. 5 Major amputation is associated with a 5-year survival of only 30-40% 6 and a markedly increased the risk of cardiovascular disease. 7 The cost of care of DMO is extraordinary, and a previous study indicated the potential economic benefits of reducing amputations to be $2,900 to $4,442 per person.…”

Current Surgical Approach in the Pathology of the Arteriopathic Predominant Diabetic Foot

“…The surgery of diabetic foot complications comprises a wide range of interventions, from incisions, debrides, transfalangeal and transmetataral amputations of toe/s or major amputations. Adjunctive treatments, such as: plastic surgery methods for the coverage of skin defects, negative pressure therapy and hyperbaric oxygenotherapy, both with the role of accelerating the process of wound granulation, represent methods that balance the evolution to healing (20,21).…”

Dakin's solution in the treatment of severe diabetic foot infections

“…Among the plethora of serious diabetes‐related complications, the diabetic foot (DF) is one of the most common, disabling, and costly, which persists as the most frequent cause of non‐traumatic lower‐extremity amputation (LEA). Major (at or above‐the‐ankle) LEAs are a particular catastrophic event, demonstrating an 80% higher mortality than minor amputations and a median survival of only 1.9 years . Major LEAs also result in profound consequences to the health‐related quality of life of the patient and his or her family and caregivers, is a source of psychological distress and scarring, and preludes exceptionally high health care expenditures and homecare costs .…”

“…Major (at or above-the-ankle) LEAs are a particular catastrophic event, demonstrating an 80% higher mortality than minor amputations and a median survival of only 1.9 years. 1 Major LEAs also result in profound consequences to the health-related quality of life of the patient and his or her family and caregivers, 2,3 is a source of psychological distress and scarring, 4 and preludes exceptionally high health care expenditures and homecare costs. 5,6 Unfortunately, preventing this unwarranted outcome is often exceptionally challenging because of a constellation of several factors, such as the aggressive and necrotising infection course, compromised arterial supply, patient's comorbidities, and delay in seeking medical care.…”