Limb salvage experience in a multidisciplinary diabetic foot unit

Area of Science:

• Vascular Surgery
• Diabetic Foot Care
• Limb Salvage

Background:

• Diabetic foot complications are a leading cause of major amputations.
• Effective management strategies are crucial for limb preservation in at-risk populations.
• A new multidisciplinary diabetic foot unit was established to address these challenges.

Purpose of the Study:

• To evaluate the effectiveness of a new strategy in preventing major amputations.
• To assess limb salvage and patient survival outcomes in patients treated by a multidisciplinary diabetic foot unit.
• To analyze results across different patient groups based on ischemia and ulceration severity.

Main Methods:

• Retrospective study of 162 patients (172 limbs).
• Patients classified into three groups: revascularization for limb-threatening ischemia (A1), non-feasible revascularization for limb-threatening ischemia (A2), and neuropathy-related foot ulcers (B).
• Data collected on revascularization procedures, gangrene resection, limb preservation, and patient survival.

Main Results:

• Group A1 (revascularization): 95% limb preservation at 1 month, 85% at 24 months; 89% patient survival at 1 month, 64% at 24 months.
• Group A2 (no revascularization): 35% limb preservation at 1 month, 17% at 24 months; 64% patient survival at 1 month, 16% at 24 months.
• Group B (neuropathy/ulcers): 98% limb preservation at 1 month, 86% at 24 months; 98% patient survival at 1 month, 68% at 24 months. Clinical exams were superior to pressure measurements for revascularization decisions.

Conclusions:

• Major amputation can be avoided in approximately 80% of patients with limb-threatening ischemia and 95% with infected foot ulcers.
• Multifactorial treatment by a multidisciplinary foot care team is essential for successful limb salvage.
• Specialized, coordinated care significantly improves outcomes for complex diabetic foot lesions.