Limb salvage experience in a multidisciplinary diabetic foot unit.
OBJECTIVE
To assess the results of the strategy used in avoiding major amputations in patients admitted to a vascular surgical department with a new multidisciplinary diabetic foot unit.


METHODS
The study was retrospective. A total of 162 patients (172 limbs) were classified into three groups. Group A1 had limb-threatening ischemia and were undergoing revascularization (85 patients, 91 legs). Group A2 had limb-threatening ischemia, but revascularization was not feasible for them (23 patients). Group B had foot ulcers due to peripheral neuropathy and did not require arterial reconstruction (54 patients, 58 legs).


RESULTS
In group A1 there were 115 revascularizations; 42 conduits had outflow to crural arteries and 14 to pedal arteries. Resection of gangrene was required in 43% of the limbs. The chances of preserved limb at 1 and at 24 months were 95 and 85%, respectively, and the chances of patient survival were 89 and 64%. In group A2, the chances of preserved limb at 1 and at 24 months were only 35 and 17%, respectively, and the chances of patient survival were only 64 and 16%. In group B, 51 of 58 limbs suffered invasive infection; debridement of the ulcers required resection of toes or part of the foot in 64% of cases. The chances of preserved limb at 1 and at 24 months was 98 and 86%; the chances of patient survival were 98 and 68%. Ankle and toe systolic pressures were less suitable than repeated clinical examinations in deciding the need for revascularization.


CONCLUSIONS
Major amputation can be avoided in about 80% of patients with limb-threatening ischemia and in about 95% with foot ulceration complicated with infection. Multifactorial treatment of the complex foot lesions by a multidisciplinary foot care team is considered mandatory to obtain satisfactory limb salvage.
Holstein
P E
PE
Department of Thoracic and Vascular Surgery I, Bispebjerg Hospital, University of Copenhagen, Denmark.
Sørensen
S
S
D000671:Amputation, Surgical; D000842:Ankle / Q000098:blood supply; D001786:Blood Glucose / Q000378:metabolism; D017719:Diabetic Foot / Q000628:therapy*; D005528:Foot / Q000098:blood supply* / Q000601:surgery; D005734:Gangrene / Q000601:surgery; D006801:Humans; D007866:Leg / Q000601:surgery; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D014034:Toes / Q000098:blood supply; D014656:Vascular Surgical Procedures
D001786:Blood Glucose