Surgical treatment of limb- and life-threatening infections in the feet of patients with diabetes and at least one palpable pedal pulse: successes and lessons learnt.
Outcomes of surgically treated limb- and life-threatening infections in patients with diabetes and a well-vascularized foot based only on the palpation of foot pulses are not well known. The authors retrospectively studied a series of 173 patients with diabetes and limb- (moderate) or life- (severe) threatening infections with at least one palpable pedal pulse who were admitted to their department for the treatment of infected diabetic foot from January 1, 1998, to December 31, 2009. A total of 141 patients (81.5%) presented with limb-threatening/moderate infections and 32 (18.5%) with life-threatening/severe infections. In all, 49 patients (28.3%) presented with soft tissue infections only, 90 (52%) with osteomyelitis and 34 (19.7%) with a combined infection. Amputation was needed in 74 patients (42.7%), of whom 6 needed a major amputation (3.5% of overall). A total of 99 (57.2%) patients were treated by conservative surgery. Four patients (2.3%) died during the postoperative period (30 days). Limb salvage was achieved in 167 (96.5%) of the patients who were followed up until healing. Healing of the wounds by secondary intention was achieved in a median of 72 days. Clinical results permit the observation that a high rate of limb salvage can be achieved after the surgical treatment of limb- and life-threatening infections in patients with at least one palpable pedal pulse.
Diabetic Foot Unit, Hospital La Paloma, C/Maestro Valle 20, Las Palmas de Gran Canaria, Canary Islands, Spain. javiaragon@telefonica.net
Javier
J
Aragón-Sánchez
Jose L
JL
Lázaro-Martínez
Cristina
C
Hernández-Herrero
Nalini
N
Campillo-Vilorio
Yurena
Y
Quintana-Marrero
Esther
E
García-Morales
Maria J
MJ
Hernández-Herrero
D000369:Aged, 80 and over; D000671:Amputation, Surgical; D016001:Confidence Intervals; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D017719:Diabetic Foot / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D016017:Odds Ratio; D010019:Osteomyelitis / Q000601:surgery; D058729:Peripheral Arterial Disease / Q000601:surgery; D011674:Pulse; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000601:surgery; D014947:Wounds and Injuries / Q000601:surgery*