Amputation considerations and energy expenditures in the diabetic patient.
Amputations are not procedures of choice but are often necessary and valuable tools for returning a patient to a more active lifestyle. Because of the comorbidities associated with diabetes, this is an important consideration. A return to a more active existence can reduce the effect of vascular disease, hyperglycemic states, and functional limitations. It is an interesting and not uncommon occurrence for the chronic wound patient, when offered an amputation, to have the procedure because the frequency of needed medical care has stripped him of his independence. The frequency of wound care in the nonhealing wound and its personal demands can be compared with the demands placed on the dialysis patient. The greatest obstacle for the uninitiated surgeon is a sense of hesitancy: Am I moving too fast to amputation as an answer? The ability to make this decision comes with experience and with prioritizing the patient's needs. Life-threatening infections and avascular extremities that are not bypassable are the easier decisions to make, as there is little choice at that point. In deciding whether to amputate, the wise surgeon will take into consideration the medical and mobility needs of each patient and determine level and timing based on understanding of the whole person.
Satterfield
Kathleen
K
Department of Orthopaedics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive/MS 7776, San Antonio, TX 78229, USA. satterfield@uthscsa.edu
D000671:Amputation, Surgical / Q000379:methods* / Q000534:rehabilitation; D003920:Diabetes Mellitus / Q000378:metabolism*; D017719:Diabetic Foot / Q000601:surgery*; D004734:Energy Metabolism; D006801:Humans; D007866:Leg / Q000601:surgery; D018579:Patient Selection