Pattern and management approach of diabetic foot disease in a developing country

Diabetes mellitus is a common endocrine illness in our environment. Diabetic foot gangrene is its commonest surgical complication and is a health burden in Niger Delta region of Nigeria. The aim of the study was to highlight the demography, bacterial incidence, time frame to development of diabetic foot, reaction to ablative surgery and the use of San Antonio wound classification system forthe treatment decision.

We retrospectively reviewed 46 diabetic feet in 41 diabetics over a 5 year period, January 1999 to December 2003, using the San Antonio classification system. The case notes of all patients seen in the University of Port Harcourt Teaching Hospital were included in the study.

There were 32 males and 9 females with a male female ratio of 3.6:1. The age range was 34 to 90 years with a mean of 56 +/- 12 years. The mean duration between diagnoses of diabetes mellitus and development of foot disease was 13 +/- 5 years. Twenty four patients (59.5%) with stages A or B irrespective of the grade had a chance of limb salvage using appropriate antibiotic, serial wound debridement, regular dressing and skin grafting where necessary. Of the 24, 3 absconded, 5 died and 16 healed and were discharged. The remaining 17 patients (40.5%) were stages C and D and were offered ablative surgery irrespective of the grade. Nine discharged against medical advice, 5 died and 3 were discharged in good condition.

This is a disease of the older population. Delay in accepting ablative surgery affects prognosis. Outcome in management of diabetic foot disease can be improved by education, early presentation, funding for establishment of specialized diabetic foot clinics and early decisive definitive management.