Trends in the presentation and surgical management of the acute diabetic foot.
BACKGROUND
This study examines trends in the presentation and surgical management of acute diabetic foot problems in a single institution.


METHODS
Prospective audit of all diabetic patients who had a primary procedure for critical lower limb ischaemia (CLI) and/or foot sepsis between 1st January 1990 and 31st December 2002. Primary and secondary intervention, mortality and limb salvage rate within 6 weeks of the index procedure were recorded.


RESULTS
There were 661 patients (417 men and 244 women of median age 69, range 31-99, years) with 799 affected limbs. CLI alone was present in 625 (78%) limbs, combined CLI and foot sepsis in 53 (7%) and foot sepsis alone in 121 (15%). The primary intervention was minor amputation in 323 (40%) limbs, revascularisation in 288 (36%), major amputation in 185 (23%) and sympathectomy in three limbs. Within 6 weeks, 125 (16%) limbs required secondary intervention, the peri-procedural mortality rate was 38 of 924 (4%), and the limb salvage rates for patients with CLI, combined CLI and sepsis and sepsis alone were 66, 66 and 80%, respectively. There was a significant decline in the proportion of patients presenting with CLI alone and a significant increase in the proportion presenting with combined CLI and sepsis and sepsis alone. In patients with CLI alone, there was a significant increase in the primary major amputation rate and a significant decline in the minor amputation rate with no significant change in the revascularisation rate.


CONCLUSIONS
There has been a progressive decline in the proportion of patients presenting with CLI alone and a greater proportion of patients presenting with an element of foot sepsis. In patients with CLI alone, the primary major amputation rate has increased at the expense of a decline in minor amputation rate.
Adam
D J
DJ
University Department of Vascular Surgery, Birmingham Heartlands Hospital, Birmingham, UK. donald.adam@heartofengland.nhs.uk
Raptis
S
S
Fitridge
R A
RA
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D017719:Diabetic Foot / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000601:surgery; D007866:Leg / Q000098:blood supply / Q000601:surgery; D008160:Lumbosacral Plexus / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D018805:Sepsis / Q000150:complications; D013562:Sympathectomy; D014656:Vascular Surgical Procedures