Major Lower Extremity Amputations due to Diabetes Mellitus Complications

Abstract

Background: Lower limbs ulcers and wounds, Charcot foot with the presence of peripheral neuropathy or peripheral vascular disease are common complications of the diabetes mellitus (DM). Major extremity amputations (below and above knee) are one of the common surgical procedures performed due to DM complications. Objective: To review the amputations performed due to diabetes mellitus (DM) complications with other associated illness, commonly isolated bacteria, and the demography of the patients in a public general hospital. Materials and Methods: We retrospectively reviewed the cases of above and below the knee amputations due to DM complications from January 2012 to December 2016. The age, gender, duration of DM anyone having, bacteria isolated, vascular condition of the lower limbs, other diseases anyone having, post-surgery wound conditions and status of the ambulation after surgery were analyzed. Results: A total of 53 amputations of the limbs of 51 patients were performed. Below knee amputations were performed on 43 (81.83%) limbs and male gender were 35(68.62%). The mean age of the patient was 57.6±12.01 years (range 31-91 years). The three most common bacteria isolated were Klebsiella pneumoniae, Staphylococcus aureus, Enterobacter cloacae. About 85% of these bacteria were sensitive to commonly used first line of antibiotics like co-amoxiclav and ciprofloxacin. Fifty cases (98.03%) had diabetes for more than five years. End stage renal disease (ESRD) and ischaemic heart disease (IHD) were the other common co-morbidities observed. Conclusion: Major lower limb amputations (below and above the knee) due to uncontrolled blood sugar are common surgical procedures performed on DM. Majority of the bacteria were sensitive to commonly used first line of antibiotics but still 15% were not sensitive and bacteria isolation, sensitivity with the drugs were also important for the treatment of the infection.