Clinical Outcomes of Ray Amputation in Diabetic Foot Patients

Abstract

Dear Editor,Diabetes mellitus is a growing problem in Singapore, with a reported incidence of 11.3% of the Singapore population, a signifi cant increase from 8.2% in 2004. 1 With the implementation of a multidisciplinary approach combined with a clinical pathway, our major amputation rate (below-and above-knee amputation) has been reduced from 31.15% in 2002 to 11.01% in 2007. 2 Nather et al in 2008 identifi ed predictive factors leading to limb loss in diabetic patients to be peripheral vascular disease and infection. 3 Minor amputations in diabetic feet surgery include toe disarticulation, ray amputation, transmetatarsal amputation, Chopart's, Lisfranc's, Syme and Pirogoff amputation. 4 The ray amputation is the commonest minor amputation performed in Singapore, and is preferred to the disarticulation of the toe. 3 Several papers have studied the outcome of minor amputation in diabetic foot patients without further classifying which type of minor amputation was performed. 5,6,7 Others have studied ray amputations in patients with and without diabetes. 8 There are few studies in the literature on the clinical outcome of ray amputation in diabetic foot patients. 9,10,11 These studies reported mainly selective aspects of clinical outcome such as mortality and recurrence of ulcers. 9,10,11 The aim of this paper is to evaluate the factors that would predict a poor outcome following a ray amputation. Materials and MethodsThis is a prospective cohort study of 150 consecutive patients with diabetic foot problems undergoing ray amputation by the National University Hospital (NUH) Diabetes Foot Team from January 2007 to October 2010. Ethics approval from the hospital's ethics board was granted. Informed consent was taken. These patients were followed up for a minimum of 12 months.Demographic data and patient profi le such as age, sex, premorbid status, duration and type of diabetes, comorbidities, presence of risk factors such as smoking, alcoholism, and hyperlipidaemia were recorded. Clinical examination included the vascular status (lower limb pulses, ankle and toe-brachial indexes) and the neuropathy

Popliteal artery patency is an indicator of ambulation and healing after below-knee amputation in vasculopaths

“…2,11,15 This rate is greater than, but comparable to, other studies’ findings. Wong et al 16 reported a 50% 1-year ambulation rate in a patient cohort similar to ours. Norvell et al and Columbo et al both reported 40% of patients maintaining preoperative ambulatory status following BKA.…”

“…2,11,15 This rate is greater than, but comparable to, other studies' findings. Wong et al 16 20,21 Furthermore, it remains evident that ambulation outcomes have trended downward over the years. In 1987, Francis and Renton 22 reported 85% successful ambulation in a cohort of 46 patients after BKA.…”

Predictive Factors for Successful Prosthetic Rehabilitation after Vascular Transtibial Amputation

“…Wong et al . also found that indicators of poor vascularization such as low ankle brachial index and absence of popliteal pulse were negative predictors of prosthetic rehabilitation ( 2 ). Further investigation should identify factors which improve outcome after TTA in patients with insufficient flow in the popliteal artery.…”

“…In the literature, this ratio ranges from 49% ( 14 ) to over 95% ( 15 ). A similar time frame of 12 months was used in previous researches ( 2 , 13 ).…”

Estrogen‐related receptor alpha is anAMPK‐regulated factor that promotes ischemic muscle revascularization and recovery in diet‐induced obese mice

“…Obesity and type II diabetes are leading risk factors for cardiovascular disease, particularly known to increase the prevalence of peripheral arterial disease (PAD) 1–3 . PAD is characterized by impaired blood supply to the limb musculature due to large artery occlusion or regression of local blood vessels in the limbs.…”