Lower extremity amputations due to diabetes; risk factors for reamputations and the role of imaging methods in determining the level of amputation

Abstract

PurposeTo reveal the causes of reamputation of patients who underwent amputation due to diabetic foot and identify the role of imaging methods in determining the level of amputation. MethodIncluded in the study were 167 patients who underwent amputation due to diabetic foot between January 2018 and January 2021. The patients were divided into two groups. Patients who did not need reamputation were included in Group I, and patients who needed reamputation were included in Group II. The following information regarding the patients were evaluated: age, gender, the amputated side, duration of diabetes mellitus (DM), presence of chronic renal failure (CRF), need for hemodialysis, Charlson Comorbidity Score (CCS), American Society of Anesthesiologists (ASA) score, presence of diabetic neuropathy, smoking, HbA1C, albumin, C-reactive protein (CRP), erythrocyte sedimentation ratio (ESR), lymphocyte-monocyte ratio (LMR), neutrophile/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), platelet-monocyte ratio (PMR), presence of diabetic foot necrosis, Exitus status of the patient and doppler ultrasonography (D-USG) and computed tomography angiography (CTA) results. ResultsThe mean age of the patients was 60.69 ± 16.37 years. No statistically significant difference was found between the groups in terms of age, gender, the amputated side, duration of DM, presence of CRF, need for hemodialysis, CCS, smoking, HbA1C, albumin, ESR, LMR, NLR, PLR, PMR or exitus status. However, a statistically significant difference was found between the groups in terms of the ASA score, neuropathy due to DM, CRP, and presence of diabetic foot necrosis (P = 0.012, P = 0.038, P = 0.000, and P = 0.026, respectively). It was found that the use of D-USG in determining the level of amputation statistically reduced the need for reamputation (P = 0.013). ConclusionsAccording to the results of the study, diabetic neuropathy, the CRP value, ASA score, and the presence of a wound on the heel increases the possibility of reamputation. Compared to CTA, D-USG provides more reliable results in determining the level of amputation due to diabetic foot.