Diabetic foot wounds in haemodialysis patients: 2‐year outcome after percutaneous transluminal angioplasty and minor amputation

Matsuzaki, Kyoichi; Miyamoto, Akira; Naohiro, Hakamata; Fukuda, Masahiro; Yamauchi, Yasutaka; Takako, Akita; Kuhara, Ryoji; Shingo, Tezuka

doi:10.1111/j.1742-481x.2012.01104.x

Cited by 8 publications

(5 citation statements)

References 17 publications

(32 reference statements)

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“…Even though PTA is considered a possible procedure to treat critical limb ischemia, there is limited literature available on the prognosis of this intervention. In a 2-year follow-up prospective study on haemodialysis patients with diabetic foot wounds who were treated with PTA and minor amputation, it was found that only 41.9% of patients survived without reamputation with a 2-year postoperative mortality rate of 38.7% [ 29 ]. This study had a small sample size of 31 haemodialysis patients; hence, it is important to explore the prognosis of PTA as treatment and prevention of amputation by doing more studies with a larger sample size.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Risk Factors of Lower Limb Amputation in Patients with End-Stage Renal Failure on Dialysis: A Systematic Review

Gilhotra

Rodrigues

Vangaveti

et al. 2016

International Journal of Nephrology

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Background. Renal dialysis has recently been recognised as a risk factor for lower limb amputation (LLA). However, exact rates and associated risk factors for the LLA are incompletely understood. Aim. Prevalence and risk factors of LLA in end-stage renal failure (ESRF) subjects on renal dialysis were investigated from the existing literature. Methods. Published data on the subject were derived from MEDLINE, PubMed, and Google Scholar search of English language literature from January 1, 1980, to July 31, 2015, using designated key words. Results. Seventy studies were identified out of which 6 full-text published studies were included in this systematic review of which 5 included patients on haemodialysis alone and one included patients on both haemodialysis and peritoneal dialysis. The reported findings on prevalence of amputation in the renal failure on dialysis cohort ranged from 1.7% to 13.4%. Five out of the six studies identified diabetes as the leading risk factor for amputation in subjects with ESRF on renal dialysis. Other risk factors identified were high haemoglobin A1c, elevated c-reactive protein, and low serum albumin. Conclusions. This review demonstrates high rate of LLA in ESRF patients receiving dialysis therapy. It has also identified diabetes and markers of inflammation as risk factors of amputation in ESRF subjects on dialysis.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Risk Factors of Lower Limb Amputation in Patients with End-Stage Renal Failure on Dialysis: A Systematic Review

Gilhotra

Rodrigues

Vangaveti

et al. 2016

International Journal of Nephrology

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“…Even if the patients use therapeutic shoes, one in three will have recurrent foot wound and will undergo reoperation. In other words, only two in five patients survive two years after minor amputation with no recurrent wounds that require an operation 10) . The frequency of reamputation is known to be higher after toe amputation as compared with that after mid-foot amputation 11) .…”

Section: Discussionmentioning

confidence: 99%

Healed Penile Necrosis in a Presumed Calciphylaxis Case Following Autoamputation

Oyadomari

Suzuki

Matsuzaki

et al. 2020

International Journal of Surgical Wound Care

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We report here a patient whose glans penis gangrene healed after autoamputation without surgery. The patient was a 52-year-old man who was diagnosed with acute exacerbation of chronic renal failure and underwent hemodialysis. Ulcers were observed on the glans penis and both toes with painful peripheral purpura. He underwent hyperbaric oxygen therapy and low-density lipoprotein apheresis while on pain management therapy. Healing of toe gangrene was achieved after percutaneous transluminal angioplasty followed by transmetatarsal amputation. Healing of glans gangrene was achieved by maintaining the affected area dry, thus enabling autoamputation. When penile or glans necrosis develops, treatment often involves surgical removal of the affected area, followed by stump plasty. In these cases, the penis or glans is shortened by the amount of skin used in the stump closure. In some cases, the suture wound does not heal due to ischemia, and additional resections may be required. On the other hand, autoamputation is less invasive and results in only minor tissue loss. If there are no symptoms of infection with glans gangrene, and if the affected areas can be kept dry, simple patient monitoring is sufficient for recovery.

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“…A report examining the prognosis after minor amputation reported that 31.5% patients required reamputation within 2 years [3]. These reports indicate that amputees are older and have a higher shortterm reamputation rate.…”

Section: Introductionmentioning

confidence: 99%

Reamputation in patients with diabetes-related minor amputations who underwent physical therapy during their hospitalization. A single-facility retrospective cohort study

Imaoka¹,

Sato²,

Furukawa³

et al. 2020

Preprint

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Background：Diabetes-related foot lesions are a major cause of non-traumatic lower limb amputations and are associated with a high re-amputation rate. Lesions can cause hindrance in activities of daily living, reduce physical function, and lower a patient’s quality of life. Physical therapy is necessary to prevent these limitations. Thus far, there has been limited investigation into the re-amputation rate in patients who have undergone physical therapy. This study aimed to elucidate modifiable risk factors for re-amputation in patients with minor amputations who were treated with physical therapy during their hospitalization.Methods：This was a retrospective cohort study of 245 consecutive hospitalized patients who presented to our Wound Care Center between January 2015 and February 2018 and received physical therapy after a minor amputation. Participants were identified from admission records (to surgical and physical therapy units) stored in the electronic medical records. We examined reamputations that occurred in the ipsilateral lower extremity during the 1-year post-discharge outpatient period. The maximum follow-up period was set at 1 year. We used Cox proportional hazards analysis to examine factors affecting the risk of reamputation.Results: Of the 129 patients enrolled, 42 patients (32.5%) underwent reamputations during an average observation period of 6.2 months (range, 2.1 to 10.9 months). The factors associated with reamputation were a requirement for hemodialysis, ankle dorsiflexion angle, and ambulation Functional Independence Measure score.Conclusions: In diabetes patients with minor amputations, requirement for hemodialysis, ankle dorsiflexion angle, and functional independence measure (FIM) ambulation were shown to be modifiable risk factors for re-amputation. This emphasizes that maintaining vascular endothelial function through lower limb muscle exercises for hemodialysis, improving ankle mobility, and off-loading walking are necessary to reduce the risk of reamputation. Patients with these risk factors should be encouraged to participate in physical therapy.

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Diabetic foot wounds in haemodialysis patients: 2‐year outcome after percutaneous transluminal angioplasty and minor amputation

Cited by 8 publications

References 17 publications

Prevalence and Risk Factors of Lower Limb Amputation in Patients with End-Stage Renal Failure on Dialysis: A Systematic Review

Prevalence and Risk Factors of Lower Limb Amputation in Patients with End-Stage Renal Failure on Dialysis: A Systematic Review

Healed Penile Necrosis in a Presumed Calciphylaxis Case Following Autoamputation

Reamputation in patients with diabetes-related minor amputations who underwent physical therapy during their hospitalization. A single-facility retrospective cohort study

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