University of Khartoum

Major Lower Extremity Amputation in Diabetics (July 2002 – January 2003) Khartoum Teaching Hospital and Gabir Abu El Izz Center

Major Lower Extremity Amputation in Diabetics (July 2002 – January 2003) Khartoum Teaching Hospital and Gabir Abu El Izz Center

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Title: Major Lower Extremity Amputation in Diabetics (July 2002 – January 2003) Khartoum Teaching Hospital and Gabir Abu El Izz Center
Author: Osman, Mohammed
Abstract: This is a prospective hospital-based study on the clinical patterns of major LEAs in diabetic patients in KTH and Gabir Abu El Izz center during the period July 2002 to January 2003. Objectives: The aim was to identify the anatomical levels and indications of major LEAs in diabetic patients undergoing major LEAs in KTH and Gabir Abu El Izz center during the period July 2002 to January 2003. The study also explored the rates of primary healing, post operative complications, reoperation, morbidity and mortality at the various levels of major LEA. Methods: Consecutive seventy diabetic patients underwent major LEA during the study period, were included. A data sheet was completed by interviewing, examining, investigating and following up all patients. Results: Seventy patients were included in this study. Their age ranged between 35-92 years with a mean age of 61.5 years ± SD 11.85.The male to female ratio was 1.5:1. Ninety-six percent had NIDDM while (4%) had IDDM. The mean duration of diabetes was 18.3years ± SD 9.04. Sixteen percent were hypertensive and nineteen percent were regular smokers. IV Eighty-six percent of our patient did not have previous foot education. Thirty patients (42.85%) had history of previous foot ulceration and thirtyone had history of previous minor or major LEA. Fifty-two patients (74.28%) had transtibial amputation and 18 had transfemoral amputation. No Symes, through knee or hip disarticulation were encountered. The ratio of transtibial to transfemoral amputation was (2.9 :1). The indication of major LEA was control of sepsis in 27 (37.14%) patients, gangrene of the foot in thirteen patients and extensive tissue loss in (18.55%), followed by various combination of sepsis, gangrene and extensive tissue loss in the remaining patients. Forty-seven LEAs (67.00%) were done under spinal anesthesia, 19 (27.00%) were done under general anesthesia and only 4 (6.00%) were done under local anesthesia. The wound was closed primarily in sixty-one patients (87.14%) and was left open in 9 patients (12.86%). The wound was closed without a drain in fifty-six patients (80.00%) and with a drain in 5 patients (7.14%). Compared to transtibial amputation transfemoral amputations were associated with statistically significant: lower primary healing rate, higher postoperative complications rate, higher reoperation rate, and higher V mortality rate. The rate of in-hospital mortality was (20%). The mean duration of hospital stay was 30.14 days±21.87 with no significant difference in the hospital stay in relation to the level of the amputation. Conclusion: Transtibial and transfemoral amputations are the main types of major LEA in diabetic patients in KTH and Gaber Abu El Izz diabetes center. The most common indication of major LEA is control of sepsis followed by gangrene of the foot and various combinations of sepsis, gangrene and extensive tissue loss. Transfemoral amputations are associated with higher rates of complications, reoperation, delayed healing and mortality.
Description: 114page
URI: http://khartoumspace.uofk.edu/handle/123456789/8754
Date: 2015-04-09


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