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Reamputation after minor foot amputation in diabetic patients: risk factors leading to limb loss.
MedLine Citation:
PMID:  23419696     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
The prevalence of lower extremity reamputation in diabetic patients has been well-documented. We sought to determine the risk factors for major lower extremity amputation (LEA) after minor foot amputation in diabetic patients. We studied 163 diabetic patients who had undergone an initial minor foot amputation and then had undergone at least 1 subsequent major or minor LEA. The patients were separated into a minor LEA group (initial minor LEA followed by at least 1 subsequent minor LEA) and a major LEA group (initial minor LEA followed by at least 1 subsequent major LEA). We then studied the possible risk factors for both groups. The possible risk factors analyzed were age, glycemic control, kidney function, previous kidney or kidney-pancreas transplantation, smoking history, and presence and severity of peripheral arterial disease (PAD). No statistical significance was found between the 2 groups for hemoglobin A1c, smoking status, chronic kidney disease, end-stage renal disease requiring dialysis, kidney or kidney-pancreas transplantation, or vascular intervention (peripheral arterial bypass). In the minor group, 22.23% had severe PAD. In the major group, 71.15% had severe PAD. This was statistically significant (p < .001). The average interval to major amputation in those without PAD, mild to moderate PAD, and severe PAD was 1,180.9, 591.0, and 559.6 days, respectively. This demonstrates the importance of assessing the peripheral vascular status in all diabetic patients with minor LEA. Early referral to a vascular surgeon might delay (or prevent) major LEA.
Authors:
Vincent S Nerone; Kevin D Springer; Darren M Woodruff; Said A Atway
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons     Volume:  52     ISSN:  1542-2224     ISO Abbreviation:  J Foot Ankle Surg     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9308427     Medline TA:  J Foot Ankle Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  184-7     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Resident, Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: vincent.nerone@osumc.edu.
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