Infected diabetic ulcers, when to amputate

Area of Science:

• Medical Research
• Diabetology
• Vascular Surgery

Background:

• Diabetic foot ulcers are a major cause of amputation, with high recurrence rates even after treatment.
• Factors beyond infection and peripheral artery disease contribute to poor wound healing in diabetic patients.

Purpose of the Study:

• To identify risk factors for amputation in patients with infected diabetic foot ulcers.
• To explore potential protective factors in diabetic wound healing.

Main Methods:

• Retrospective study of 139 patients with infected diabetic ulcers (2012-2017).
• Data collected included HbA1c, comorbidities (coronary heart disease), C-reactive protein (CRP), ejection fraction (EF), and prior amputations.
• Multidisciplinary team follow-up (infectious disease, orthopedics, vascular surgery).

Main Results:

• 36.9% of infected diabetic ulcers resulted in amputation.
• Amputation risk factors identified: HbA1c > 8%, coronary heart disease, EF < 50%, CRP > 80 mg/L, and previous amputations.
• Patients treated with dihydropyridine calcium channel blockers exhibited lower ulcer prevalence and fewer amputations.

Conclusions:

• Specific clinical indicators (high HbA1c, CAD, low EF, elevated CRP, prior amputations) predict amputation risk in diabetic foot ulcers.
• Dihydropyridine calcium channel blockers may play a protective role in managing diabetic foot complications.