Risk factors for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based case–control study

Pemayun, Tjokorda Gde Dalem; Naibaho, Ridho M.; Novitasari, Diana; Amin, Nurmilawati; Minuljo, Tania Tedjo

doi:10.3402/dfa.v6.29629

Cited by 134 publications

(156 citation statements)

References 45 publications

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“…In terms of the effects of laboratory findings on amputation, Beaney et al [18] reported that HbA1c levels higher than 7.5% had an impact on amputation. In the study of Pemayun et al [19], HbA1c ≥8% and triglycerides ≥150 mg/dL were also found to have significant effects on amputation. Decreased Hb and elevated CRP were reported to have significant effects on amputation in another study [17].…”

Section: Discussionmentioning

confidence: 92%

“…In the study of Demirci et al [13], 23 of 52 patients had osteomyelitis. Pemayun et al [19] also reported that 27 of 47 amputated cases had osteomyelitis. However, the relation between osteomyelitis and amputation was not significant.…”

Section: Discussionmentioning

confidence: 95%

“…According to Pemayun et al [19], the WagnerMeggitt Classification of Grade 4 had a significant impact on amputation. Jeon et al [17] used five different classification systems for DFU and found all to be effective in predicting amputation.…”

Section: Discussionmentioning

confidence: 99%

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Factors Affecting Amputations in Patients with Diabetic Foot Ulcer Referring To the Emergency Units

İçer¹,

Durgun²

2017

Dicle Tıp Dergisi

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Objective: Diabetic foot is the most common cause of lower extremity amputations. The aim of the present study was to investigate the clinical characteristics of and factors affecting amputation in patients with diabetic foot ulcer referring to the emergency units. Methods: The present study was performed based on retrospective review of medical files of 58 patients who were referred to the Emergency Unit of Dicle University, Faculty of Medicine between June 2010 and October 2016 due to diabetic foot ulcer. Results: Of 58 patients included in this study, 31 (53.4%) were men and 27 (46.6%) were women. The mean age was 61.43±11.584 (range: 41 to 85) years. Extremity amputation was not performed in 34 patients (58.6%), while 24 (41.4%) underwent an amputation. Factors affecting extremity amputation were found to be disease duration, presence of coronary artery disease, duration of hospital stay, and presence of osteomyelitis. Among laboratory findings, factors affecting extremity amputation were albumin, hemoglobin, leukocytes, neutrophil, neutrophil/lymphocyte ratio, hemoglobin A1c, and elevated erythrocyte sedimentation rate. The Wagner-Meggitt Classification of Grade 4, University of Texas Classification of stage D and Grade 3 also had significant effects on amputation. (p<0.05) Conclusion: Our study results suggest that together with classification systems, comorbidities, albumin levels, hemoglobin A1c levels, sedimentation rate, and complete blood count results play a key role in predicting the amputation requirement in patients with diabetic foot ulcers referring to the emergency units.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 95%

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Factors Affecting Amputations in Patients with Diabetic Foot Ulcer Referring To the Emergency Units

İçer¹,

Durgun²

2017

Dicle Tıp Dergisi

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“…PAD is a known risk factor for diabetic foot amputation, [22] with a 29% amputation rate and 55% 5-year mortality associated with ischemic DFU. Our studies have also shown that many diabetic patients present with PAD in combination with other comorbidities, including hypertension (70%) and end stage renal disease (50%).…”

Section: Discussionmentioning

confidence: 99%

Preliminary evidence using negative pressure wound therapy to achieve limb salvage for the ischemic diabetic foot

Fang¹,

Chen²,

Chang³

et al. 2016

PAR

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How to cite this article: Fang JCC, Chen YT, Chang YS, Shen JH, Chen ML, Chang CC. Preliminary evidence using negative pressure wound therapy to achieve limb salvage for the ischemic diabetic foot. Plast Aesthet Res 2016;3:378-83.Aim: Negative pressure wound therapy (NPWT) in diabetic foot ulcers (DFU) has been discussed in several studies, but without a focus on peripheral arterial disease (PAD), which is a common comorbidity. This study aims to investigate the feasibility of NPWT in the treatment of DFU with PAD in regards to limb salvage and the clinical course. Methods: The authors retrospectively collected patients with DFU and PAD diagnosed with either Doppler ultrasound or angiography as the PAD study group. Patients with DFU but no PAD were enrolled as the non-PAD comparison group. NPWT was applied to both PAD and non-PAD subjects. Results: There were 10 patients in the PAD group and 3 patients in the non-PAD group. In the PAD Key words:Negative pressure wound therapy, diabetic foot ulcer, ABSTRACTArticle history:

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“…Diabetes is a worldwide epidemic, affecting almost 194 million people, including 20.8 million in the United States . A main cause for hospital admissions for diabetic patients is morbidity related to foot ulcers, where 15% of diabetic patients suffer foot ulcers, of which 84% will progress to lower‐leg amputations . A principal cause of foot ulcers is delayed wound healing that was not caught clinically.…”

Section: Introductionmentioning

confidence: 99%

Characterisation of impaired wound healing in a preclinical model of induced diabetes using wide‐field imaging and conventional immunohistochemistry assays

Saidian

Lakey

Ponticorvo

et al. 2018

International Wound Journal

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Major complications of diabetes lead to inflammation and oxidative stress, delayed wound healing, and persistent ulcers. The high morbidity, mortality rate, and associated costs of management suggest a need for non‐invasive methods that will enable the early detection of at‐risk tissue. We have compared the wound‐healing process that occurs in streptozotocin (STZ)‐treated diabetic rats with non‐diabetic controls using contrast changes in colour photography (ie, Weber Contrast) and the non‐invasive optical method Spatial Frequency Domain Imaging (SFDI). This technology can be used to quantify the structural and metabolic properties of in‐vivo tissue by measuring oxyhaemoglobin concentration (HbO2), deoxyhaemoglobin concentration (Hb), and oxygen saturation (StO2) within the visible boundaries of each wound. We also evaluated the changes in inducible nitric oxide synthase (iNOS) in the dermis using immunohistochemistry. Contrast changes in colour photographs showed that diabetic rats healed at a slower rate in comparison with non‐diabetic control, with the most significant change occurring at 7 days after the punch biopsy. We observed lower HbO2, StO2, and elevated Hb concentrations in the diabetic wounds. The iNOS level was higher in the dermis of the diabetic rats compared with the non‐diabetic rats. Our results showed that, in diabetes, there is higher level of iNOS that can lead to an observed reduction in HbO2 levels. iNOS is linked to increased inflammation, leading to prolonged wound healing. Our results suggest that SFDI has potential as a non‐invasive assessment of markers of wound‐healing impairment.

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Risk factors for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based case–control study

Cited by 134 publications

References 45 publications

Factors Affecting Amputations in Patients with Diabetic Foot Ulcer Referring To the Emergency Units

Factors Affecting Amputations in Patients with Diabetic Foot Ulcer Referring To the Emergency Units

Preliminary evidence using negative pressure wound therapy to achieve limb salvage for the ischemic diabetic foot

Characterisation of impaired wound healing in a preclinical model of induced diabetes using wide‐field imaging and conventional immunohistochemistry assays

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