Lower-extremity amputations in patients with diabetes: pre- and post-surgical decisions related to successful rehabilitation

Abstract

What is generally recognized is that there are disparities in the rates of amputation for type 1 versus type 2 diabetic patients, for different ethnic groups and for patients with multiple co-morbidities. However, with advances in surgical techniques and with modern prosthetics, all categories of patients are benefiting from surgeries in which a longer residual limb can be kept (within surgical constraints related to proper wound healing), and where appropriate biomechanical considerations are taken into account.

The effect of pulsed bipolar dc on the simultaneous extraction of glucose and lactate by reverse iontophoresis

“…These may be in the form of stroke [16][17][18], peripheral vascular disease [16,17,19,20], blindness [16,21], or renal failure [16,17,22,23]. Diabetes is also the leading cause of non-trauma related amputations [16,24]. Most diabetics currently use finger-prick capillary samples which they analyse on a reagent strip in a portable meter [25].…”

A comparative study on lower extremity amputation (LEA) stump outcome in diabetic and non-diabetic patients in a tertiary care hospital of Raipur City, Chhattisgarh, India

“…The most frequently encountered postoperative complications were wound infection in 16% followed by wound dehiscence in 8.5%. 17 found that healing in most cases correlated with patency of distal blood flow. They concluded that there were no universally accepted methods for objectively determining successful wound healing.…”

The use of a dermal substitute to preserve maximal foot length in diabetic foot wounds with tendon and bone exposure following urgent surgical debridement for acute infection

“…• this retrospective study serves to evaluate the utility of a specific dermal substitute for preserving maximal foot length • all patients referred to our Diabetic Foot Center for rest pain and/or foot ulcer or gangrene were assessed for sensory-motor neuropathy, infection and chronic critical limb ischaemia (CLI) • the degree of amputation, if deemed necessary, was based on the amount of apparently non infected vital tissue • when vital tendon and bone tissue remained exposed and when it was considered possible to carry out a more distal amputation instead of primary closure with a more proximal amputation, the lesion was covered with a dermal substitute (Integra ® Dermal Regeneration Template, Integra LifeSciences Corporation), provided that local and systemic infections were under control as indicated by subsidence of fever, normalisation of leukocyte count and disappearance of clinical signs of inflammation in the foot techniques and the adoption of multidisciplinary approaches for managing diabetic foot disease have enhanced limb salvage rates (1,2). Treatment of feet presenting with infection or widespread gangrene consists of surgical removal of the infected soft and non vital bone tissues, often leading to minor amputation even at proximal levels (i.e.…”

“…Improvements in diagnostic and therapeutic techniques and the adoption of multidisciplinary approaches for managing diabetic foot disease have enhanced limb salvage rates (1,2). Treatment of feet presenting with infection or widespread gangrene consists of surgical removal of the infected soft and non vital bone tissues, often leading to minor amputation even at proximal levels (i.e.…”