Amputation-free limb survival in diabetic foot lesions: A Review

Abstract

In this review, we examine the current status of amputation-free survival among patients with diabetic foot lesions in terms of the prevalence of diabetic foot lesions and amputations among diabetics. Next, we examine the etiological factors that are responsible for the development of diabetic foot lesions and subsequent amputation. We have previously conducted a retrospective investigation from 2004 to 2007. From our analysis of the data collected over this period from patients with diabetic foot lesions, we were able to identify some of the main etiological categories related to the risk for amputation. Based on these etiological categories, we were able to develop a color-coded etiological key that can be easily applied in clinical practice for the assessment of the risk of amputation and thereby direct the referral and further management. Between 2007 and 2012, we conducted a prospective study to test the applicability of the etiological key. The amputation-free survival rates achieved with thiskey were found to be comparable to those reported with the use of the currently applied approach of using a multidisciplinary team. We found that changes in blood quality, mainly, anemia and hypoalbuminemia, and peripheral artery disease were the etiological factors that were associated with the least chances of requiring amputation. On the other hand, tissue loss and pervious surgical procedures were found to be indicators of the highest risk for amputation. We also examine the etiological factors conventionally considered to increase the risk of amputation and examine the current practices followed in the management of cases of diabetic foot. We also examine the traditional and advanced treatment options available for the various etiological factors with a view to reducing amputations. We believe that our etiological key has the potential for widespread applicability in developing countries where resources for a multidisciplinary approach may be scarce