Incidence of reamputation and death after gangrene of the lower extremity

Abstract

Since 1972 the Danish Amputation Register (DAR) has recorded major amputations in Denmark. The register is based on voluntary detailed reports from surgical and orthopaedic departments. The present investigation is based upon 2029 amputations for arteriosclerotic and diabetic gangrene with an observation period up to 4 years. The incidence of ipsilateral reamputation is high in the immediate postoperative period with 10-4% after one month, 16-5% after three months and 18-8% after six months. Later the incidence is quite low, reaching a total of 23-1% after four years. The risk of contralateral amputation is ever present with an incidence of 11-9% within one year, 17-8% after two years, 27-2% after three years, and finally 44-3% after four years. The mortality after three months is 16-3% and then tapers off to a total of 22-5% after four years. As compared with the normal population a significant over-mortality is seen during the first three months, and an equally significant under-mortality from six months onward during the observation period.

Revision Rate and Risk Factors After Lower Extremity Amputation in Diabetic or Dysvascular Patients

“…In the current study, mean time to revision was 244 days. These results are analogous to those of Ebskov and Josephsen, 16 who reported that the majority of ipsilateral reamputations occurred within the first year. Kanade et al 17 reported that the second ipsilateral amputations in their study population oc- curred after an average of 21 weeks.…”

The Epidemiology of Diabetic Foot Problems

“…At 48 months following amputation this figure had increased only another 4% to 23 %. 18 Descriptive studies have reported that approximately 6-30% of amputees will undergo second leg amputations within 1 to 3 years of their initial amputation. 18 · 36 · 37 · 39 Table 4 reports the frequency of second leg amputations among initial amputation survivors.…”

Management of Diabetic Nephropathy

“…They are frequent causes of lower extremity amputations in diabetics. Once the loss of one limb has occurred, the prognosis of the contralat-era1 one is poor (35). Measures to prevent foot ulcers and amputations entail patient education, frequent examinations of the feet, wearing of well-fitting shoes, use of heel booties in bed-ridden patients and regular visits to a podiatrist.…”