Lower limb amputations in Nigeria: An appraisal of the indications and patterns from a premier teaching hospital

Abstract

Background: The most common indication for lower limb amputations in Nigeria is not known. Almost all studies on amputations in Nigeria considered lower and upper extremities together and report varying leading indications. Major lower limb amputation imposes a significant health burden on the patient and deserves effort at its prevention. The aim of the present study was to determine the predominant indication and patterns of lower limb amputations from a Nigerian premier teaching hospital to enable appropriate preventive recommendations. Materials and Methods: The operative records of patients who underwent lower limb amputation surgeries in the premier University of Nigeria Teaching Hospital, east of Nigeria, between January 2013 and December 2017 were retrospectively analyzed for the indications, levels of amputations, and patient characteristics. Results: Ninety-three unilateral lower limb amputations were performed within the 5-year period. There were 52 (55.9%) males with an M:F ratio of 1.3:1. The mean age of the patients was 52.23 years. Trans-tibial amputation was more commonly performed (51.6%), followed by trans-femoral (45.2%). Diabetic foot (DF) gangrene constituted the dominant indication (57%) and accounted for 54.8% of all the major amputations. The next common indication was tumors (19.3%). Foot gangrene from diabetes and from nondiabetic peripheral arterial diseases (10.8%) accounted for 67.8% of the indications. Conclusions: Major lower limb amputations predominate from this study, with peripheral vascular diseases (PVDs), especially due to diabetes mellitus, being the leading cause. Appropriate public health advocacy on DF complications and establishment of comprehensive multidisciplinary foot-care services, capable of prevention, diagnosis, and treatment of early DF lesions, will help reduce the incidence of DF gangrene. This measure will, no doubt, lower the high rate of major lower limb amputations.