Treatment of the diabetic foot – to amputate or not?

Weledji, Elroy Patrick; Fokam, Pius

doi:10.1186/1471-2482-14-83

Cited by 85 publications

(55 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[3–5] Surgical interventions may be needed to manage diabetic foot infections; these vary from minor to major interventions, such as debridement or amputation. [6,7] The rate of lower extremity amputation (LEA) among patients with diabetes may be as high as 70%, and the most frequent cause of nontraumatic LEA is a diabetic foot ulcer. [8–10] …”

Section: Introductionmentioning

confidence: 99%

Comparison of the effects of remifentanil-based general anesthesia and popliteal nerve block on postoperative pain and hemodynamic stability in diabetic patients undergoing distal foot amputation

et al. 2016

View full text Add to dashboard Cite

Diabetic foot ulcer is the most common cause of diabetes-associated nontraumatic lower extremity amputation. Most patients who undergo lower extremity amputation for a diabetic foot have had diabetes for a long time and suffer from multiorgan disorder; thus, it can be a challenge to ensure sufficient anesthetic and analgesic effects while maintaining stable hemodynamics. Recently, peripheral nerve block has gained popularity owing to its attenuating effects of systemic concerns. This retrospective observational study aimed to compare the effects of remifentanil-based general anesthesia (GEA) and popliteal nerve block (PNB) on postoperative pain and hemodynamic stability in diabetic patients undergoing distal foot amputation.A total of 59 consecutive patients with a diabetic foot who underwent distal foot amputation between January 2012 and May 2014 were retrospectively reviewed. Patients received remifentanil-based GEA (GEA group, n = 32) or PNB (PNB group, n = 27). The primary outcomes were to evaluate postoperative analgesic effects and perioperative hemodynamics. Also, postoperative pulmonary complications and 6-month mortality were assessed as secondary outcomes.Significant differences in pain scores using numeric rating scale were observed between the groups in a linear mixed model analysis (PGroup×Time = 0.044). Even after post hoc analysis with the Bonferroni correction, the numeric rating scale scores were significantly lower in the PNB group. Furthermore, patients in the PNB group required less pethidine during the first 6 hours after surgery (27 ± 28 vs 9 ± 18 mg; P = 0.013). The GEA group had a lower mean blood pressure (Bonferroni-corrected P < 0.01), despite receiving more ephedrine (P < 0.001). Significantly more patients in the GEA group suffered from postoperative pneumonia and required the management in intensive care unit (P = 0.030 and 0.038, respectively). However, the groups did not differ in terms of 6-month mortality.This study demonstrated that compared with remifentanil-based GEA, PNB might be a favorable option for diabetic patients undergoing distal foot amputation, despite the lack of significant mortality benefits, as PNB was associated with improved postoperative analgesia, hemodynamic stability, and a low incidence of pulmonary complications during the immediate postoperative period, especially in high-risk patients.

show abstract

Section: Introductionmentioning

confidence: 99%

Comparison of the effects of remifentanil-based general anesthesia and popliteal nerve block on postoperative pain and hemodynamic stability in diabetic patients undergoing distal foot amputation

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Most infected DFUs require some surgical intervention, ranging from minor to major interventions, including debridement and amputation, respectively. Infected DFUs are a major cause of lengthy hospital admission and contribute to more than a million amputations per year [8], with a 50% 5-year mortality rate amongst diabetic amputees [9].…”

Section: Diabetic Wound Healingmentioning

confidence: 99%

Healing Effects of Photobiomodulation on Diabetic Wounds

Houreld

2019

Applied Sciences

View full text Add to dashboard Cite

Diabetic patients frequently develop chronic ulcers of the lower extremities, which are a frequent cause for hospitalization and amputation, placing strain on patients, their families, and healthcare systems. Present therapies remain a challenge, with high recurrence rates. Photobiomodulation (PBM), which is the non-invasive application of light at specific wavelengths, has been shown to speed up healing of chronic wounds, including diabetic foot ulcers (DFUs). PBM produces photophysical and photochemical changes within cells without eliciting thermal damage. It has been shown to promote tissue regeneration and speed up wound repair by reducing inflammation and oxidative stress, accelerating cell migration and proliferation, and promoting extracellular matrix production and release of essential growth factors. The shortage of rigorous, well-designed clinical trials makes it challenging to assess the scientific impact of PBM on DFUs, and lack of understanding of the underlying mechanisms also hinders the conventional use of this therapy. This review gives a glimpse into diabetic wound healing and PBM, and the effects of PBM on diabetic wound healing.

show abstract

“…6 Grave complications are associated with chronic wounds that are not adequately managed and persist; in patients with comorbidities such as diabetes, lower extremity amputation may be required, 7 and the five year mortality following such an intervention stands at 50%. 8 With our ageing population and an increasing incidence of diabetes and obesity, the number of individuals affected by chronic wounds is set to rise. 9,10 To help address the current difficulties that this condition presents, it will be vital to identify agents that are capable of reducing or eradicating the biofilm burden associated with the wound bed, thereby removing a major impediment to healing.…”

Section: Introductionmentioning

confidence: 99%