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https://hdl.handle.net/2440/22886
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Type: | Journal article |
Title: | Trends in the presentation and surgical management of the acute diabetic foot |
Author: | Adam, D. Raptis, S. Fitridge, R. |
Citation: | European Journal of Vascular and Endovascular Surgery, 2006; 31(2):151-156 |
Publisher: | W B Saunders Co Ltd |
Issue Date: | 2006 |
ISSN: | 1078-5884 1532-2165 |
Statement of Responsibility: | D.J. Adam, S. Raptis and R.A. Fitridge |
Abstract: | Background: This study examines trends in the presentation and surgical management of acute diabetic foot problems in a single institution. Method: 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. Conclusion: 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. |
Keywords: | Diabetic foot, Surgery, Workload |
Rights: | Copyright © 2005 Elsevier Ltd All rights reserved. |
DOI: | 10.1016/j.ejvs.2005.05.039 |
Published version: | http://dx.doi.org/10.1016/j.ejvs.2005.05.039 |
Appears in Collections: | Aurora harvest 6 Surgery publications |
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