Long-term results following operation for diabetic foot problems: arterial disease confers a poor prognosis.
OBJECTIVE
to describe the long-term outcome of local amputations and debridements of diabetic feet, with special reference to the presence or absence of arterial disease.


METHODS
a consecutive series of 75 diabetic patients having local foot surgery during 1987-92 was reviewed in 1998. A total of 136 operations had been done on 92 limbs, of which 52 (60%) had evidence of arterial disease. Survivors were interrogated in 1998, with follow-up intervals of 69-120 (median 92) months after their index operations.


RESULTS
complete healing occurred in 48% feet, and 36% limbs required major amputation, after 1 day-7 years (median 24 days). Major amputation was more common in limbs with arterial disease (52% vs. 18%) -p;<0.001. At follow-up 20 (27%) patients were alive (five lost to long-term follow-up) - five of 44 (11%) arteriopaths, and 15 of 26 (58%) of those without arterial disease (p<0.001). No patient who had arterial reconstruction at the outset survived to follow-up. Among the survivors, 78% feet had remained healed, with no recurrent ulceration.


CONCLUSIONS
among diabetics requiring local foot surgery, the presence of arterial disease confers a poor long-term prognosis for both life and limb. Those with neuropathy alone tend to do well with good foot care.
Campbell
W B
WB
Department of Surgery, Royal Devon and Exeter Hospital, Exeter, EX2 5DW, United Kingdom.
Ponette
D
D
Sugiono
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001157:Arterial Occlusive Diseases / Q000209:etiology; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003646:Debridement; D003925:Diabetic Angiopathies / Q000209:etiology; D017719:Diabetic Foot / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000098:blood supply; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome