Predictors of Lower Extremity Amputation and Reamputation Associated With the Diabetic Foot

Acar, Erdinç; Kaçıra, Burkay Kutluhan

doi:10.1053/j.jfas.2017.06.004

Cited by 59 publications

(38 citation statements)

References 18 publications

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“…TM amputation has been associated with a 29–35 per cent reamputation risk, whereas TT and TF amputations have been associated with risk of 12–25 per cent and 8 per cent respectively. In addition, multiple health factors have been shown to affect reamputation risk, including male sex, smoking, alcohol use, rest pain/gangrene, anticoagulant and aspirin use, increased international normalized ratio, increased white blood cell count/sepsis and history of revascularization. These summaries inform population risk, but do not inform individual patient risk, which is essential for incorporation into treatment planning decisions.…”

Section: Discussionmentioning

confidence: 99%

Predicting reamputation risk in patients undergoing lower extremity amputation due to the complications of peripheral artery disease and/or diabetes

Czerniecki

Thompson

Littman

et al. 2019

British Journal of Surgery

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Background Patients undergoing amputation of the lower extremity for the complications of peripheral artery disease and/or diabetes are at risk of treatment failure and the need for reamputation at a higher level. The aim of this study was to develop a patient‐specific reamputation risk prediction model. Methods Patients with incident unilateral transmetatarsal, transtibial or transfemoral amputation between 2004 and 2014 secondary to diabetes and/or peripheral artery disease, and who survived 12 months after amputation, were identified using Veterans Health Administration databases. Procedure codes and natural language processing were used to define subsequent ipsilateral reamputation at the same or higher level. Stepdown logistic regression was used to develop the prediction model. It was then evaluated for calibration and discrimination by evaluating the goodness of fit, area under the receiver operating characteristic curve (AUC) and discrimination slope. Results Some 5260 patients were identified, of whom 1283 (24·4 per cent) underwent ipsilateral reamputation in the 12 months after initial amputation. Crude reamputation risks were 40·3, 25·9 and 9·7 per cent in the transmetatarsal, transtibial and transfemoral groups respectively. The final prediction model included 11 predictors (amputation level, sex, smoking, alcohol, rest pain, use of outpatient anticoagulants, diabetes, chronic obstructive pulmonary disease, white blood cell count, kidney failure and previous revascularization), along with four interaction terms. Evaluation of the prediction characteristics indicated good model calibration with goodness‐of‐fit testing, good discrimination (AUC 0·72) and a discrimination slope of 11·2 per cent. Conclusion A prediction model was developed to calculate individual risk of primary healing failure and the need for reamputation surgery at each amputation level. This model may assist clinical decision‐making regarding amputation‐level selection.

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Section: Discussionmentioning

confidence: 99%

Predicting reamputation risk in patients undergoing lower extremity amputation due to the complications of peripheral artery disease and/or diabetes

Czerniecki

Thompson

Littman

et al. 2019

British Journal of Surgery

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“…11,19 Treatment of active infection Wound infection is a known predictor of poor wound healing and amputation. 20 The appropriate recognition of infection and treatment with antibiotics in diabetic foot infection is imperative to improve outcomes. Conversely, inappropriately treating with antibiotics, often in the setting of fear of missing an infection, to reduce bacterial burden or prophylaxis is associated with several adverse effects, including antibacterial resistance.…”

Section: Surgical Debridementmentioning

confidence: 99%

Update on management of diabetic foot ulcers

Everett

Mathioudakis

2018

Annals of the New York Academy of Sciences

500

354

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Diabetic foot ulcers (DFUs) are a serious complication of diabetes that results in significant morbidity and mortality. Mortality rates associated with the development of a DFU are estimated to be 5% in the first 12 months, and 5-year morality rates have been estimated at 42%. The standard practices in DFU management include surgical debridement, dressings to facilitate a moist wound environment and exudate control, wound off-loading, vascular assessment, and infection and glycemic control. These practices are best coordinated by a multidisciplinary diabetic foot wound clinic. Even with this comprehensive approach, there is still room for improvement in DFU outcomes. Several adjuvant therapies have been studied to reduce DFU healing times and amputation rates. We reviewed the rationale and guidelines for current standard of care practices and reviewed the evidence for the efficacy of adjuvant agents. The adjuvant therapies reviewed include the following categories: nonsurgical debridement agents, dressings and topical agents, oxygen therapies, negative pressure wound therapy, acellular bioproducts, human growth factors, energy-based therapies, and systemic therapies. Many of these agents have been found to be beneficial in improving wound healing rates, although a large proportion of the data are small, randomized controlled trials with high risks of bias.

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“…Wound infection is a common and serious problem in patients with diabetes, and is admitted as a risk factor for lower extremity amputations, especially with multidrug-resistant infection (10)(11)(12). On the surface of ulceration, structured community of microbial cells would form a biofilm gradually to advance their own survival.…”

Section: Discussionmentioning

confidence: 99%

A Severe Diabetic Foot Ulcer With Intermediate Cuneiform Displacement and Multidrug-Resistant Pseudomonas aeruginosa Infection: A Rare Case Report

et al. 2020

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Diabetic foot ulcer (DFU) is considered as one of the most serious and prevailing complications of diabetes mellitus, while it is the major cause of amputations in diabetic patients. Herein, we reported an acquired severe traumatic DFU with an intermediate cuneiform hairline fracture and displacement in a 55-year old male (Grade IV of Wagner classification; Grade III of IWGDF classification). The Pseudomonas aeruginosa was identified in pus culture. Data of antibiotic susceptibility testing indicated that the isolates of Pseudomonas aeruginosa were multi-drug resistant. Routine debridement, clearing displaced intermediate cuneiform and drainage were performed to facilitate the outflow of pus and pressure mitigation. Dressing with Prontosan solution and gel was applied to the wound, and meropenem was systemically administrated in addition to effective glycemic control. The DFU has been fully healed after ∼40-day treatment. For this case, clearing the displaced and fractured intermediate cuneiform is essential for the heal of the DFU in addition to the common strategy for DFU treatment, i.e., the combination of debridement, pressure mitigation, wound dressing with Prontosan, antibiotic selection and effective glycemic control. This case report might have value for the treatment of complex DFU with bone fracture and displacement, reducing the risk of amputation.

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Predictors of Lower Extremity Amputation and Reamputation Associated With the Diabetic Foot

Cited by 59 publications

References 18 publications

Predicting reamputation risk in patients undergoing lower extremity amputation due to the complications of peripheral artery disease and/or diabetes

Predicting reamputation risk in patients undergoing lower extremity amputation due to the complications of peripheral artery disease and/or diabetes

Update on management of diabetic foot ulcers

A Severe Diabetic Foot Ulcer With Intermediate Cuneiform Displacement and Multidrug-Resistant Pseudomonas aeruginosa Infection: A Rare Case Report

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