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FACTORS RELATED TO AMPUTATION LEVEL AND WOUND HEALING IN DIABETIC PATIENTS
Daniel Baumfeld1, Tiago Baumfeld1, Benjamim Macedo2
1Hospital das Clínicas, Belo Horizonte, MG, Brazil.
Insights
Determining the optimal amputation level in diabetic patients is crucial. This study found that limb ischemia and prior amputations increase major amputation risk, while preoperative antibiotics offer protection.
Area of Science:
- Diabetic foot complications
- Surgical outcomes
- Limb salvage
Background:
- Diabetic patients often require lower limb amputations due to infection and ischemia.
- Lack of defined criteria complicates amputation level determination.
Purpose of the Study:
- To identify clinical and laboratory factors influencing amputation level in diabetic patients.
- To assess predictors of wound healing time after amputation.
Main Methods:
- Retrospective analysis of 139 diabetic patients undergoing amputation.
- Evaluation of surgery type, antibiotic use, lab values, and hospital stay.
Main Results:
- Transmetatarsal amputation was most common (28.9%).
- Delayed healing linked to debridement, no preoperative antibiotics, and no vascular intervention.
- Major amputations associated with limb ischemia, prior amputations, and lack of preoperative antibiotics.
Conclusions:
- Targeting distal amputations improves walking energy expenditure and quality of life.
- Limb ischemia and previous amputations are risk factors for major amputations.
- Preoperative antibiotic therapy is a protective factor against major amputations.
Objective:
There are no specific criteria that define the level of amputation in diabetic patients. The objective of this study was to assess the influence of clinical and laboratory parameters in determining the level of amputation and the wound healing time.
Methods:
One hundred and thirty-nine diabetic patients were retrospectively assessed. They underwent surgical procedures due to infection and/or ischemic necrosis. Type of surgery, antibiotic use, laboratory parameters and length of hospital stay were evaluated in this study.
Results:
The most common amputation level was transmetatarsal, occurring in 26 patients (28.9%). The wound healing time increased with statistical significance in individuals undergoing debridement, who did not receive preoperative antibiotics and did not undergo vascular intervention. Higher levels of amputation were statistically related to limb ischemia, previous amputation and non-use of preoperative antibiotics.
Conclusion:
Patients with minor amputations undergo stump revision surgery more often, but the act of always targeting the most distal stump possible decreases energy expenditure while walking, allowing patients to achieve better quality of life. Risk factors for major amputations were ischemia and previous amputations. A protective factor was preoperative antibiotic therapy.
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