title: Salvaging diabetic foot through debridement, pressure alleviation, metabolic control, and antibiotics.
abstract: There is a fatalist perception of diabetic foot because the argument of "small-vessel disease" prevails. This is the report of a cohort study of patients facing a formal recommendation for major foot amputation to assess how many can be saved with a conventional treatment, defined as debridement, pressure alleviation, metabolic control, and antibiotics. The primary efficacy measurement was the salvage of the limb at the follow-up visit between 25 and 35 days after the first consultation. The secondary efficacy measurement was the subsequent epithelization of the ulcerative lesions, following patients for up to 270 days. The cohort consisted of 105 type 2 diabetic patients; 87 (83%) had severe lesions. A total of 71 patients (68%) required hospitalization. By the intention-to-treat analysis, 89 patients (85%) avoided major amputation. A total of 88 patients were evaluated for complete epithelization, reaching median success by day 120. Overall, 51 patients (49%) underwent minor amputations. It was concluded that there is a high rate of unnecessary major foot amputations, because a diabetic foot can be salvaged across the continuum of severity when patients receive care in a multidisciplinary wound clinic.
authors.affiliation: Diabetic Foot Clinic Cabeza de Vaca, Leon Guanajuato, Mexico.
authors.forename: Francisco G
authors.initials: FG
authors.lastname: Cabeza de Vaca
authors.forename: Alejandro E
authors.initials: AE
authors.lastname: Macias
authors.forename: Welsy A
authors.initials: WA
authors.lastname: Ramirez
authors.forename: Juan M
authors.initials: JM
authors.lastname: Munoz
authors.forename: Jose A
authors.initials: JA
authors.lastname: Alvarez
authors.forename: Juan L
authors.initials: JL
authors.lastname: Mosqueda
authors.forename: Humberto
authors.initials: H
authors.lastname: Medina
authors.forename: Jose
authors.initials: J
authors.lastname: Sifuentes-Osornio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003646:Debridement; D017719:Diabetic Foot / Q000628:therapy*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D016879:Salvage Therapy; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents