Prognosis of critical limb ischemia: Major vs. minor amputation comparison

Abstract

Healthcare providers treating wounds have difficulties assessing the prognosis of patients with critical limb ischemia who had been discharged after complete healing of major amputation wounds. The word "major" in "major amputation" gives the impression of "being more severe" than "minor amputation." Therefore, even if wounds are healed after major amputation, they imagine that prognosis after major amputation would be poorer than that after minor amputation. We investigated the prognosis of diabetic nephropathy patients 2 years after amputations. Those patients underwent dialysis as well as amputation following percutaneous transluminal angioplasty for their foot wounds. They were ambulatory prior to these surgeries. Among 56 cases of minor amputation, 45 were males and 11 were females, and mortality was 41.1%. The mortality of cases with and without a coronary intervention history was 53.1% and 25.0%, respectively (p = 0.034). Among 10 cases of major amputation, 9 were males and 1 was female, and mortality was 60%. The mortality of cases with and without a coronary intervention history was 75.0% and 0%, respectively. Although we predicted poor prognosis in cases with major amputation, there was no significant difference in mortality 2 years after amputations (p = 0.267). Thus far poor prognosis has been reported for major amputation. It might be due to inclusion of the following patients: patients with wounds proximal to ankle joints, patients with extensive gangrene spreading to the lower legs, patients with septicemia from wound infection and who died around the time of operation, and patients with malnutrition. The results of our present study showed that the outcomes at 2 years postoperatively were similar between patients with major amputations and those with minor amputations, if surgical wounds were able to heal. We should not estimate the prognosis by the level of amputation, rather we should consider the effect of coronary intervention history on prognosis.

The Geriatric Nutritional Risk Index Independently Predicts Mortality in Diabetic Foot Ulcers Patients Undergoing Amputations

“…Furthermore, whether the surgical procedure of minor LEA was too conservative in some severe cases who should have had a higher level of amputation was not known. Our findings again stress the point that the coronary artery disease [22] and renal function [18] are associated with mortality in diabetic patients after lower extremity amputations.…”

“…However, the study from Taiwan found that major amputation is not an associated risk factor for mortality after adjusting for sex and age [21]. Another study demonstrated that there is no difference in prognosis between major and minor amputations at two years if the surgical wounds could heal [22]. In our study, wounds healed after amputations among most patients, which might explain that the level of amputation was not associated with mortality.…”

egative Pressure Wound Therapy: The Experience of Our Surgery Department

“…Some have studied the NPWT in amputations and proved that patients who underwent amputation and who had negative pressure wound therapy had less major amputation than patients with conventional dressing [12]. However, Mendonca et al, has reported that patients with severe peripheral vascular disease should be treated by other methods because of high failure rate [13]. Which was the case of three of our patients who underwent another amputation.…”

Effects of Anesthetic Techniques on the Risk of Postoperative Complications Following Lower Extremity Amputation in Diabetes Patients with Coagulation Abnormalities: A Retrospective Cohort Study Using Propensity Score Analysis

“…Only patients with below-knee or more distal-level amputation were included in this study, as above-knee amputation (AKA) is not performed under PNB alone in our institution. Below-knee amputation (BKA) was regarded as a major amputation, whereas a more distal-level amputation was regarded as a minor amputation [ 14 , 15 , 16 , 17 ]. Amputation of the forefoot, midfoot, and hindfoot were considered minor.…”